Appeals Case Manager II

Guardian Life

. Adjudicate assigned appeals for Group Life and Disability claims .

Posted 10/12/2026full-timeRemote • United StatesMid-LevelSenior💰 $58,620 - $96,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in adjudicating Group Life and Disability claims, ensuring compliance with ERISA and relevant regulations. Proficient in problem-solving, analytical assessment, and providing exceptional customer service in a fast-paced environment.

Highest-signal resume keywords

Group Disability Claims ExperienceLife Claims ExperienceERISA Compliance KnowledgeAnalytical SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationReconsideration ReviewsRegulatory ComplianceInvestigative SkillsPlan Provisions AssessmentMedical EvaluationFinancial EvaluationProblem-Solving SkillsMathematical SkillsResearch Skills

Soft Skills

Client FocusVerbal CommunicationWritten CommunicationFlexibilityAdaptability

Industry Keywords

Department of Labor GuidelinesAppeals ProcessShort-Term DisabilityLong-Term DisabilityWaiver of PremiumClaim ResolutionCompliance ScenariosWorkload PrioritizationCustomer ServiceClaims Insights

About the role

Key responsibilities & impact

Adjudicate assigned appeals for Group Life and Disability claims
Provide full and fair reconsideration reviews as required under ERISA
Assess claim files and apply plan provisions in accordance with state and federal regulations
Support Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals
Plan, implement and execute investigations of 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 in consultation with clinical/vocational professionals
Provide proactive outreach and customer service to internal and external customers
Identify legal and compliance scenarios requiring additional research and facilitate resolution
Maintain current knowledge of ERISA and Department of Labor guidelines
Prioritize workload according to deadlines
Share insights and learnings with claims colleagues
Report to the Leader - Appeals Team

Requirements

What you’ll need

High School Diploma or GED required
Minimum of 5 years of Group Disability and/or Life Claims experience
Strong client focus with excellent verbal and written communication skills
Demonstrated problem-solving, analytical, mathematical, and research skills
Ability to manage multiple priorities and tasks while ensuring compliance with applicable regulatory requirements
Flexibility and adaptability in response to changing business needs
Minimum of 3 years of experience handling appeals and/or complex claims preferred
Bachelor's degree or equivalent combination of education and professional experience preferred
Legally authorized to work in the United States without current or future employer sponsorship/support
Ability to travel to Guardian offices as determined by the People Leader

Benefits

Comp & perks

Competitive compensation package
Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period
Life and disability insurance
401(k) with company match
Tuition assistance
Paid parental leave
Backup family care
Skill-building and leadership development opportunities
Philanthropic opportunities
Flexible time off
Flexible dress code
Flexible work location policies
Employee Resource Groups
Social responsibility and volunteering opportunities
Educational alliances with colleges
Sustainability initiatives