Disability/Absence Claims Case Manager 1

The projected pay rate for this position is $21.64 per hour, with a 3% annual bonus target.  This is a good faith estimate of base pay for the primary location of this position.  The pay for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate.  In addition, this role may also be eligible for annual, sales, or other incentive compensation.

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 planholder to assess and facilitate job accommodation opportunities
• Proactive outreaches to claimants, planholders, 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 claimant’s own job
• Determine Insured Earnings by reviewing payroll information from the planholder; 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
• 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

Reporting Relationships

• This position reports to a Team Leader, STD/Absence.

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

•  High School Diploma or GED required.
• STD, Statutory, or Family Medical Leave (FML experience preferred or other equivalent work experience.
• Regulatory and Compliance experience is a plus
• Ability to provide expectational customer service by communicating clearly and professionally.
• Ability to prioritize and multi-task while navigating through multiple business applications in a fast-paced environment.
• Successful completion of a job-related assessment is required.

Travel

• Very minimal travel, only as needed

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 [email protected]. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant. you must be legally authorized to work in the United States, without the need for employer sponsorship.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (“AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to [email protected], making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via [email protected].

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here. 

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