Claims Case Manager I

(Level 4)

Position Summary

The STD Claims Case Manager I (CM) is responsible for administering and medically managing Group Short Term Disability claims according to the plan provisions, state and federal guidelines, and established protocols. The CM works jointly with other team members and other group product lines such as Family Medical Leave (FML), Long Term Disability (LTD), Professional Resource Team (PRT), and Compliance. The CM must demonstrate the knowledge to work independently, interpret contract provisions, and utilize critical thinking skills for medical management to administer benefits throughout the life of the claim. The CM is responsible for meeting key service deliverables such as turnaround times, quality assurance, and overall customer experience.

This position utilizes problem solving and analytical, written, and verbal communication skills to ensure timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers. This position will review claims for Short Term Disability and requires consistent and effective claim management skills to succeed in a collaborative, team-oriented culture with a goal to drive positive claim outcomes.

Qualified candidates who move forward in the process can expect the following:

An invitation to take a 15-minute candidate assessment will be sent via email though our third-party vendor, Glider. There will be a series of questions related to your experience in handling various customer issue examples, your internet connectivity, and your typing accuracy and speed.
Selected candidates will then be scheduled to interview with the recruiter and then next step the hiring manager via Microsoft Teams video-based interviewing. You will be asked to provide specific examples of your professional experiences.
Candidates that have been chosen to move forward will be made an offer of employment within one week of the interview, typically in a group setting via Microsoft Teams. This will foster the same sense of community that you will find in training as well as in your career at Guardian.

Candidate Responsibilities

Effectively understand contract language and plan design for group disability
Communicate claim status and decisions via telephone and in writing
Initiate communications to claimant, physician, and plan holder to assess and facilitate job accommodation opportunities
Proactive outreaches to claimants, plan holders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. current earnings, other income benefits, medical information, etc.); notifies claimants when claims are pended for missing information
Proactively develop and execute an appropriate plan of action for pending and ongoing disability claims assigned by utilizing, managing, and directing appropriate resources. Conduct timely and accurate benefit determination in accordance with policy provisions and regulatory and internal standards while providing sound customer service to all internal and external customers
Investigate and analyze claim information in conjunction with contract provisions to determine coverage and benefit eligibility
Recognize and adapt to fast-paced environment
Determine if claimants meet the definition of disability as defined in the contact by reviewing occupational level and analyzing medical information
Establish, document, and execute claim action plan and recommended path including return to active work at claimants own job
Determine Insured Earnings by reviewing payroll information from the plan holder; then, calculate payable benefits according to plan provisions
Follow all claim management procedures and facilitate potential return to work and job accommodation opportunities when applicable
Utilize claim management resources such as MDA (Medical Disability Guidelines) and other disability tools to assist with appropriate durational disability decisions based on the medical information obtained from the provider
Assess claim when other sources of income are received (e.g., social security, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits, as needed, to determine under/overpayments. Proactively work with claimants to recover overpayments in full or negotiate monthly installments according to established protocols
Assess claim for restrictions and limitations to establish appropriate partnership with PRT
Assess claim for appropriate transition from STD to LTD

Reporting Relationships

This position reports to an STD Team Leader, who, in turn, reports to the Manager of STD Claims.

Location & Vaccination Requirements

The primary location for this position is remote, with an at home work arrangement.
Covid 19 vaccinations not required unless you voluntarily visit one of our campus locations or are attending an in-person company sponsored event.

Remote

Functional Skills

Outstanding customer service
Excellent analytics
Strong math aptitude
Ability to manage multiple priorities and meet departmental 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 multi-task, balance goals and prioritize
Ability to work independently and within a highly collaborative team environment
Read and interpret medical information
Strong skillset in Microsoft Windows applications (e.g., Microsoft Word, Excel, Outlook)
Effective and efficient time management

Leadership Behaviors

Continuously strives to achieve superior results
Expresses oneself in a confident and trustworthy manner
Demonstrates a sense of urgency in a fast-paced work environment
Demonstrates the ability to adapt to change

Position Qualifications

4-year college degree preferred or equivalent work/education experience
STD claim management experience preferred or other previous Group insurance experience
Regulatory and Compliance experience is a plus

Travel

Very minimal travel, only as needed

Our Promise:

At Guardian, youll 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.

We Offer:

Meaningful and challenging work opportunities to accelerate technology and innovation in a secure and compliant way.
Competitive compensation
Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period
Life and disability insurance
A great 401(k) with match
Tuition assistance, paid parental leave and backup family care.
Dynamic, modern work environments that promote collaboration and creativity.
Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability, and advocate for diversity & inclusion in all that we do.

Primary Location:

Remote - United States

Other Locations:

Job:

Customer Service

Schedule:

Full time

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.