Grow your career with Guardian in our newly created opportunity as a Claim Case Manager II, Supplemental Health ! In a culture where “People Count,” “We Do the Right Thing,” and “We Hold Ourselves to Very High Standards”, we are interested in individuals who are committed to customer satisfaction and an ability to make quick and accurate decisions for wellness benefits. Once proficient, you will be responsible for Accident, Hospital Indemnity, Cancer and Critical Illness claim decision making according to the plan provisions, state and federal guidelines, and established protocols. You must demonstrate the ability to work independently and to make decisions; and possess the knowledge and experience which allows performance of daily activities of the job with minimal direction.

You will

Investigate and analyze claim information to determine coverage and benefit eligibility, perform pre-existing condition investigation and draft adverse determination letter if applicable.

Review claim documentation to determine benefits available against policy guidelines. Once benefits established, determine corresponding type of service codes and benefit amounts for processing.

Assess file to determine if benefits are available under other product lines.

Utilize claim management resources, i.e., spreadsheets for various blocks of business, and other processing guidelines.

Proactively outreach to claimants, planholders, and physicians via telephone for information needed on initial and ongoing claim management (medical information, accident details, hospital services).

Communicate claim status and decisions via telephone and in writing.

Prioritize and review new claims to adhere to established departmental turnaround times.

Meet productivity requirements as established by department for handling Supplemental Health Claims.

Leadership Behaviors

Demonstrates intellectual curiosity.

Displays technical and functional competence and expertise.

Proactively looks at new and different ways of approaching work.

You have

Experience of 3 plus years processing Supplemental Health claims. (Accident, Critical Illness, Cancer and Hospital Indemnity)

Knowledge of Supplemental Health products, administration, and claims procedures.

Claim processing experience preferred or working knowledge of claims processes.

Excellent PC skills with knowledge of MS Word/Excel/PPT.

Bachelor’s Degree or equivalent work experience required.

Ability to problem solve systematic issues or changes based on standard and non-standard administration of claim benefits.

Agility in handling multiple tasks, responding rapidly to changing priorities, and working with tight deadlines.

Ability to keep the Voice of the Customer (VOC) forefront by demonstrating a proactive approach to problem solving or looking at continuous improvement.

Excellent decision making and communication skills.

Location

Flexible - Will consider remote candidates if experience is aligned and ability to travel to Guardian offices as required, determined by the People Leader. Preference given to candidates within commuting proximity to a Guardian Office which include:

Bethlehem, PA

Hudson Yards, New York City

Holmdel, NJ

Pittsfield, MA

Salary Range

$48,190.00 - $72,280.00

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.

Health Care

Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

Dental plan

Vision plan

Health care accounts – flexible spending, health reimbursement, and health savings accounts

Critical illness insurance

Life and Disability Insurance

Company-paid Life and Disability insurance plus voluntary supplemental coverage

Accident insurance

Retirement and Financial

401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

Flexible work arrangements (part in-person/part remote)

Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

Emotional well-being, mental health, and work/life resources powered by Spring Health

Wellness programs, including fitness program and equipment reimbursement

Child, adult, and elder back-up care support through Bright Horizons

Adoption assistance

College planning

Tuition reimbursement

Student loan assistance

Commuter benefits in select metropolitan areas

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] .