Claims Case Manager I, Supplemental Health

We are seeking energetic and compassionate individuals to join our team as Claim Case Manager 1, Supplemental Health Claims (CM I).   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, CM I will be responsible for Accident and Hospital Indemnity 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 supervision.

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

• Knowledge of Guardian’s 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

Remote/Flexible – work from home. May be expected to come into a Guardian work location occasionally, as determined by their people leader.

Salary Range

$39,370.00 - $59,050.00

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

• Compliment