Claims Case Manager II (NE)

Position Summary

The Group Life Claims Case Manager II is responsible for paying beneficiaries of members life and AD&D claims.  They will spend 6-8 weeks in training followed by at least 3 months of reviewing live eligibility claims while being mentored.  The Group Life Claims Case Manager II then begins to build an active claim caseload while being mentored on benefit determinations.  Once the Group Life Claims Case Manager II is released from mentoring, the Group Life Claims Case Manager II will be subject to 3 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 II 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 II consults with Group Life Case Manager III /Mentors, management, legal, and investigative resources.

You Have:

• 2-5 plus years of Group Life Claims Case Manager experience
• 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 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

Salary Range:

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. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits. 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 disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. 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 applicant_accommodation@glic.com.

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.