Student Veterans of America Jobs

Complex Claims Manager, LTD Claims

The Complex Claims Manager, LTD Claims is responsible for making accurate decisions on assigned complex claims according to the plan provisions, state and federal guidelines, and established protocols. This position will manage a portfolio of claims which have complexities driven by things including but not limited to specialized contractual requirements, unique earnings, complex medical conditions, specialized occupational demands and/or the presence of potential fraud, waste and abuse indicators.

You are:

A highly motivated and reliable individual who is able to work with varying levels of supervision – independently and collaboratively. You are detail oriented and a decisive decision maker who is able to manage multiple complex priorities at the same time with a positive attitude.

You have:

• A minimum of 2 years of Group LTD claims experience

• Bachelor’s Degree (preferred) or equivalent professional experience

• A client focus with excellent verbal and written communication skills.

• Demonstrated ability to manage multiple tasks in accordance with regulatory requirements

• The ability to remain flexible due to changing business needs

• Excellent written and verbal communication skills

• Ability to exercise independent and sound judgement in decision making

• Ability to analyze evidence for discrepancies

• Ability to conduct research using multiple techniques

• Excellent time management and organizational skills

• Basic computer skills and knowledge, including Microsoft Office

• Understanding of basic medical terminology and medical conditions helpful

You will:

• Utilize strong claim management skills to plan, implement and execute the investigation of a case load of complex LTD claims

• Identify and interpret relevant plan language and thoroughly investigate all claim issues to make accurate and non-biased claim determination

• Evaluate complex medical, occupational, financial and other claim information in consultation with clinical, vocational or financial specialists internal and/or external to the company

• Partner with the legal department as needed to evaluate the application of complex contractual provisions

• Maintain current knowledge of all ERISA and Department of Labor guidelines

• Independently prioritize workload based on individual and departmental deadlines

• Evaluate appeal reversals to establish ongoing claim management plans

• Readily share insights and learnings with claims colleagues

• Strategize with multiple business partners as appropriate on complex claim matters to help drive the most appropriate claim outcomes

Leadership Behaviors

• Continuously strives to provide superior products and customer service

• Expresses oneself in an open and honest manner

• Demonstrates self-awareness and embraces feedback

Reporting Relationship:

The Complex Claims Case Manager, LTD Claims reports to the Manager, LTD Complex Claims and Financial Management

Salary Range

$56,200.00 - $92,335.00

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 applicant_accommodation@glic.com .

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .