What are the responsibilities and job description for the Claims Case Manager II position at Guardian Life?
**Position Summary**
The Group Life Claims Case Manager will spend 6-8 weeks in eligibility training followed by at least 3 months of reviewing live eligibility claims while being mentored. The Group Life Claims Case Manager then begins to build an active claim caseload while being mentored on benefit determinations. Once the Group Life Claims Case Manager is released from mentoring, the Group Life Claims Case Manager will be subject to 5 months of audits for learning and extra training purposes. This position utilizes problem solving, analytical, written and verbal communication skills to deliver timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers.
After the training periods have ceased, this position is responsible for making 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.
The Group Life Claims Case Manager 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 in order to make an eligibility determination. The Group Life Case Manager consults with Group Life Case Manager III /Mentors, management, legal, and investigative resources.
**You Have:**
Outstanding customer service skills
Excellent analytical skills
Strong math aptitude 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
Utilize 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 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
**Reporting Relationships**
This position reports to the Group Life Claims Team Leader, who in turn, reports to the Group Life Claims Manager.
**Travel**
This position requires travel between local office and training sites.
© Copyright 2021 The Guardian Life Insurance Company of America, New York, NY
**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.
**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.
**Salary Range**
$47,240.00 - $78,740.00
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.
**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
**Justice, Equity, Diversity & Inclusion (J.E.D.I.)**
Employee Resource Groups that advocate for inclusion and diversity
J.E.D.I. certification and training programs
Matching gifts/volunteering
_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.
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [ Email address blocked ] - Click here to apply to Claims Case Manager II .
Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being - mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .
The Group Life Claims Case Manager will spend 6-8 weeks in eligibility training followed by at least 3 months of reviewing live eligibility claims while being mentored. The Group Life Claims Case Manager then begins to build an active claim caseload while being mentored on benefit determinations. Once the Group Life Claims Case Manager is released from mentoring, the Group Life Claims Case Manager will be subject to 5 months of audits for learning and extra training purposes. This position utilizes problem solving, analytical, written and verbal communication skills to deliver timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers.
After the training periods have ceased, this position is responsible for making 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.
The Group Life Claims Case Manager 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 in order to make an eligibility determination. The Group Life Case Manager consults with Group Life Case Manager III /Mentors, management, legal, and investigative resources.
**You Have:**
Outstanding customer service skills
Excellent analytical skills
Strong math aptitude 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
Utilize 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 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
**Reporting Relationships**
This position reports to the Group Life Claims Team Leader, who in turn, reports to the Group Life Claims Manager.
**Travel**
This position requires travel between local office and training sites.
© Copyright 2021 The Guardian Life Insurance Company of America, New York, NY
**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.
**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.
**Salary Range**
$47,240.00 - $78,740.00
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.
**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
**Justice, Equity, Diversity & Inclusion (J.E.D.I.)**
Employee Resource Groups that advocate for inclusion and diversity
J.E.D.I. certification and training programs
Matching gifts/volunteering
_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.
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [ Email address blocked ] - Click here to apply to Claims Case Manager II .
Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being - mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .
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Salary : $47,240 - $78,740
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