Job Description

at Guardian Life in Dover, Delaware, United States

The Group Life Claims Case Manager II is responsible for paying Group Life and AD&D Insurance claims to our planholder’s beneficiaries. As a part of this position, you will spend 6-8 weeks in eligibility training followed by at least 3 months of reviewing live eligibility claims while being mentored. You will then begin to build an active claim caseload while being mentored on benefit determinations. Once released from mentoring, you will be subject to 5 months of audits for learning and extra training purposes.

This position uses problem solving, analytical, written, and verbal communication skills to deliver timely and appropriate disability claim decisions while providing outstanding customer service to all internal and external customers. After the training periods have ceased, you will make all decisions on assigned claims through proactive case management according to the plan provisions, state and federal guidelines, and established protocols. This position consults with the mentors and other team members.

This role administers claims within a variety of group sizes ranging from small (2+ lives) to large market (1000+ lives). This position is responsible for ensuring all plan provisions are satisfied to make an eligibility determination. The Group Life Case Manager II consults with Group Life Case Manager III /Mentors, management, legal, and investigative resources.

You have

+ High School Diploma or GED required.

+ 5+ plus years of Group Life Claims Case Manager experience.

+ Outstanding customer service skills.

+ Excellent analytical skills.

+ Strong math proficiency skills and PC skills (e.g., Microsoft Word & Excel).

+ Ability to multi-task and meet turnaround times.

+ Demonstrate independent problem solving and decision-making ability.

+ Ability to clearly communicate claim decisions and contract language verbally and in written correspondence.

+ Ability to work independently and within a highly collaborative team environment.

+ Claim experience or product knowledge strongly preferred.

+ Regulatory and Compliance experience a plus.

+ Understanding of medical terminology helpful.

You will

+ Investigate and analyze claim information to determine coverage and benefit eligibility.

+ Perform accidental death investigation and draft adverse determination letter if applicable.

+ Perform contestability investigation, evaluate for possible rescission, make rescission determination, and draft rescission letter if applicable.

+ Perform dependent confinement investigation and draft adverse decision letter if applicable.

+ Determine Insured Earnings by reviewing payroll records, tax returns (including W2s), and partnership records and calculate payable benefits according to plan provisions within payment authority assigned by management.

+ Track and record statistical data such as benefit volumes and ICD9 codes for reserves, reports, and future profitability.

+ Prioritize and review incoming mail, correspondence, and new claims to adhere to established turn-around times.

+ Use all available resources to determine any change in claimant’s condition or work status to determine potential for gainful return to work.

+ Maintain imaged claim files and system notes in an orderly and systemic manner.

+ Calculate payable benefits according to the applicable plan provisions.

+ Meet quality and turnaround standards as required in the department.

+ Professionally and clearly communicate claim status and decisions via telephone and in writing.

+ Proactive outreach to claimants, planholders, and physicians via telephone for information needed to determine eligibility (proof of loss, attendance/payroll, investigative reports, etc.).

+ Refer appropriate claims for review to Group Life Claims Case Manager IIIs, Team Leader.

+ Adopt and support the Group Life Claims team mission and concept.

+ Participate in job development and growth.

The above description includes the most significant duties performed. However, other occasional work assignments not mentioned are assumed to be included. Management reserves the right to assign and/or reassign duties and responsibilities at any time.

Location

+ Remote/Flexible-This is a flexible, remote position. You may be expected to come into a Guardian work location occasionally, as determined by their people leader with up to 10% travel.

Salary Range

$48,190.00 – $72,280.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

+ Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

+ Dental plan

+ Vision plan

+ Health care accounts – flexible spending, health reimbursement, and health savings accounts

+ Critical illness insurance

Life and Disability Insurance

+ Company-paid Life and Disability insurance plus voluntary supplemental coverage

+ Accident insurance

Retirement and Financial

+ 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

+ Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

+ Flexible work arrangements (part in-person/part remote)

+ Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

+ Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

+ Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

+ Emotional well-being, mental health, and work/life resources powered by Spring Health

+ Wellness programs, including fitness program and equipment reimbursement

+ Child, adult, and elder back-up care support through Bright Horizons

+ Adoption assistance

+ College planning

+ Tuition reimbursement

+ Student loan assistance

+ Commuter benefits in select metropolitan areas

Equity & Inclusion

Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:

+ Employee Resource Groups:

+ Colleague Connection Committees

+ Community Involvement Committees

A culture that encourages colleagues to bring their authentic selves to work

+ Voluntary self-ID

+ Pronunciation and phonetic spelling of names

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabiliti

Job Tags

Similar Jobs