Appeals Case Manager II

🔥 9 minutes ago

🇺🇸 United States – Remote

💵 $58.6k - $96.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Guardian Life

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1860

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

💰 Non Equity Assistance on 2016-08

Healthcare • Consulting • Food & Beverage

Guardian Life is a comprehensive insurance provider offering a wide range of insurance products and services. Founded 160 years ago, the company has grown to serve over 12 million people daily. Guardian Life specializes in various insurance plans, including life, disability, dental, vision, accident, critical illness, and hospital indemnity insurance. The company also provides workforce solutions such as group benefits, absence management, paid leave, and benefits technology. Furthermore, Guardian Life offers investment services, annuities, and retirement plans, supported by financial professionals. The firm is committed to social responsibility, equity, and inclusion, partnering with organizations to foster well-being and financial health. With a strong network and deep industry experience, Guardian Life continues to be a reliable partner in protecting individuals and families while preparing them for the future.

📋 Description

• Adjudicate assigned appeals for Group Life and Disability claims • Provide full and fair reconsideration reviews as required under ERISA • Assess claim files and apply plan provisions in accordance with state and federal regulations • Support Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals • Plan, implement and execute investigations of disputed claims • Ensure timely and compliant appeal resolution • Identify and interpret relevant plan language and investigate claim issues • Evaluate medical, financial and other claim information in consultation with clinical/vocational professionals • Provide proactive outreach and customer service to internal and external customers • Identify legal and compliance scenarios requiring additional research and facilitate resolution • Maintain current knowledge of ERISA and Department of Labor guidelines • Prioritize workload according to deadlines • Share insights and learnings with claims colleagues • Report to the Leader - Appeals Team

🎯 Requirements

• High School Diploma or GED required • Minimum of 5 years of Group Disability and/or Life Claims experience • Strong client focus with excellent verbal and written communication skills • Demonstrated problem-solving, analytical, mathematical, and research skills • Ability to manage multiple priorities and tasks while ensuring compliance with applicable regulatory requirements • Flexibility and adaptability in response to changing business needs • Minimum of 3 years of experience handling appeals and/or complex claims preferred • Bachelor's degree or equivalent combination of education and professional experience preferred • Legally authorized to work in the United States without current or future employer sponsorship/support • Ability to travel to Guardian offices as determined by the People Leader

🏖️ Benefits

• Competitive compensation package • Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period • Life and disability insurance • 401(k) with company match • Tuition assistance • Paid parental leave • Backup family care • Skill-building and leadership development opportunities • Philanthropic opportunities • Flexible time off • Flexible dress code • Flexible work location policies • Employee Resource Groups • Social responsibility and volunteering opportunities • Educational alliances with colleges • Sustainability initiatives