- A minimum of 5 years of Group Disability and/or Life claims experience.
- A minimum of 3 years of experience handling appeals or complex claims (preferred).
- Bachelor's Degree (preferred) or equivalent professional experience.
- A client focus with excellent verbal and written communication skills.
- Strong problem solving, analytical, math aptitude and information research skills.
- Demonstrated ability to manage multiple tasks in accordance with regulatory requirements.
- The ability to remain flexible due to changing business needs.
- Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution.
- Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non biased appeal determination.
- Evaluate medical, financial, and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.
- Utilize proactive outreach to provide superior customer service to all internal and external customers.
- Identify legal and/or compliance scenarios that require additional research; facilitate resolution.
- Maintain current knowledge of all ERISA and Department of Labor guidelines.
- Independently prioritize workload based on individual and departmental deadlines.
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Appeals Case Manager II - Boise, United States - Idaho State Job Bank
Description
Appeals Case Manager II at Guardian Life in Boise, Idaho, United States Job Description P os ition S u mma ry Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team.
The ACM 2 provides a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations.
This role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.Y o u a re A highly motivated and reliable individual who is able to work with varying levels of supervision - independently or collaboratively.
You are detail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude.
Y o u ha v e
