Appeals Case Manager I at ReedGroup Management, LLC in Westminster, Colorado

Job Description:

APPEALS CASE MANAGER I

Do you want to be part of a collaborative Appeals team? The Appeals Case Manager I is responsible for review of adverse benefit determinations for STD and LTD claims. The Appeals Case Manager I will determine the appropriate claim determination on appeal, based on the information in the claim file and any additional information submitted as part of the appeal process. You will ensure that legal and ethical standards are met for the appeal and will maintain current knowledge of all ERISA/Department of Labor guidelines. For Non-ERISA plans, procedural accuracy must be followed. The Appeals Case Manager will comply will all regulatory requirements by making a fair, thorough, and timely appeal determination. 

You Will:

• Plan, implement, and execute the process of investigating STD and LTD claims that are in dispute; and effectively track and manage assigned case load of claim appeals.


• Evaluate medical, financial, and non-medical information, as developed, and consult with internal and external professionals regarding issues in dispute for the purpose of resolving claims.       


• Provide clear and comprehensive communication to insureds, plan holders, attorneys, and others by phone, e-mail and mail with respect to issues in dispute.


• Interpret policy provisions, state and federal regulations, department procedures and compliance directives.


• Mentor Case Managers by serving as an advisor and provide guidance on the interpretation and administration of contract language.


• Provide appropriate feedback to help assess the training needs of the organization and participate in ongoing training and development offerings to enhance appeal administration skills.

You Have:

• High School diploma or commensurate level of education required. (Bachelor’s degree preferred)


• Must possess superior knowledge of disability products and claim management


• Intermediate knowledge of Microsoft Office, including Outlook and Word


• Expert knowledge of state and federal compliance issues impacting claim administration and appeals


• ERISA compliance claim review experience


• Working medical knowledge (i.e., medical terminology, medical conditions)


• Demonstration of good judgment, professionalism, and the ability to handle confidential information


• Must possess strong interpersonal (oral and written) communication skills and a positive attitude


• Well organized, able to multi-task and identify priorities

Location:

• Remote – WFH Flexibility

Reporting Relationships:

• As our Appeals Case Manager, you will report to the Manager of Group Disability Claims

Our Promise:

• 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 innovation in a secure and compliant


• Competitive compensation package


• 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 company match


• Tuition assistance paid parental leave and backup family care


• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent


• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best


• Employee Resource Groups that advocate for inclusion and diversity in all that we do


• 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

About ReedGroup:

As the largest exclusive provider of absence management services, ReedGroup has been dedicated to helping employees return to work safely for more than 35 years. We create a seamless experience so clients can excel at their jobs and better serve their employees – supporting a thriving, engaged, and skilled workforce.

ReedGroup is a wholly-owned, independent subsidiary of The Guardian Life Insurance Company – providing even more ways we can better serve people. Guardian has been helping people protect their futures and secure their lives for more than 150 years, and today serves 27 million people by helping them find financial confidence and well-being in life, health, and wealth. And as one of the largest mutual insurance companies, we know what matters most:  putting the needs of customers first.

ReedGroup 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.

Equal Employment Opportunity: 

Reed 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.

Guardian has been helping people protect their futures and secure their lives for more than 160 years. Every day, we serve approximately 27 million people through a range of insurance and financial products. As one of the largest mutual insurance companies, we know what matters most: putting the needs of our customers first. Because everyone deserves a Guardian. Learn more about Guardian at guardianlife.com

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.

© Copyright 2019 The Guardian Life Insurance Company of America, New York, NY.