Appeals Case Manager II – Group Disability Insurance
Employment Information
Job Description
Appeals Case Manager II adjudicating Group Life and Disability claims for Guardian. Responsible for investigation and compliant appeal resolution in a remote work setting.
Responsibilities:
- Adjudicate assigned appeals for Group Life and Disability claims
- Provide full and fair reconsideration review of claims
- Thoroughly assess claim file and apply plan provisions
- Support Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals
- Utilize effective claim management skills to investigate 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
- Provide superior customer service to all customers
- Maintain current knowledge of ERISA and Department of Labor guidelines
Requirements:
- A minimum of 5 years of Group Disability and/or Life claims experience
- A minimum of 3 years of experience handling appeals or complex claims (preferred)
- Bachelor’s Degree (preferred) or equivalent professional experience
- A client focus with excellent verbal and written communication skills
- Strong problem-solving and analytical skills
- Ability to manage multiple tasks in accordance with regulatory requirements
Benefits:
- Annual, sales, or other incentive compensation
- Support and flexibility to achieve professional and personal goals
- Skill-building and leadership development opportunities
- Philanthropic opportunities to build communities
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