[Remote] Short Term Disability/Absence Claims Case Manager I

Note: The job is a remote job and is open to candidates in USA. Guardian Life is a leading insurance company seeking a Short Term Disability/Absence Claims Case Manager I. The role involves administering and managing Short Term and Absence claims, ensuring compliance with guidelines, and providing excellent customer service to claimants and healthcare providers.

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

Skills

• High School Diploma or GED required
• Ability to provide exceptional 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
• STD, Statutory, or Family Medical Leave (FML) experience preferred or other equivalent work experience
• Regulatory and Compliance experience is a plus

Benefits

• Annual bonus target of 3%
• Support and flexibility to achieve your professional and personal goals
• Skill-building
• Leadership development
• Philanthropic opportunities
• Contemporary, supportive, flexible, and inclusive benefits and resources

Company Overview