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Guardian Life State Mandated Disability Paid Family Leave Claim Case Manager in Boston, Massachusetts

This position utilizes problem solving, analytical, written and verbal communication skills to ensure timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers. This position will review claims on both New York and New Jersey statutory coverages. This position requires consistent and effective claim management skills to succeed in a collaborative, team-oriented culture and a goal to drive positive claim outcomes.

CANDIDATE RESPONSIBILITIES

Communication (Verbal and Written) 30%

  • Communicate claim status and decisions via telephone and in writing

  • Proactive outreach to claimants, planholders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. current earnings and other income benefits, medical information, job description, etc.)

Investigate/Analyze - 30%

  • Investigate and analyze claim information to determine coverage and benefit eligibility, and draft adverse determination letters when applicable.

  • Utilize claim management resources, i.e. MDA (Medical Disability Advisor), Nurse Case Manager and Voc Rehab

  • Determine disability by comparing functionality with job description by reviewing medical information including physician statement(s) and medical records then establish claim action plan and recommended path, including return to active work status

  • Determine Insured Earnings by reviewing payroll records, tax returns (including W2s), partnership records and buy sell agreements and calculate payable benefits according to plan provisions within global payment authority of $78,000.00.

  • Prioritize and review incoming mail, correspondence and new claims to adhere to established State-mandated turnaround times

  • Assess claim when other sources of income are received (e.g., social security, subrogation. etc.,) to ensure accurate offsets are applied and recalculate benefits as needed determining under/overpayments.

  • Proactively work with claimants to recover overpayments in full or negotiate monthly instalments according to established protocols

Partnering - 10%

  • Work in conjunction with Risk Management area to assess functionality by utilizing available resources

  • Partner with Long Term Disability to ensure proper management of claims with potential to transition to LTD.

REPORTING RELATIONSHIPS

This position reports to the Team Leader, Group Disability Claims, who, in turn, reports to the Manager, Group Disability Claims

CANDIDATE QUALIFICATIONS

Functional Skills

  • Outstanding customer service skills

  • Excellent analytical skills

  • Strong math aptitude skills

  • Ability to multi-task, balance goals, priorities, and meet turnaround times

  • Demonstrate independent problem solving and decision-making ability

  • Ability to clearly communicate claim decisions and contract language verbally and in written correspondence

  • Strong problem solving and communication skills; verbal & written

  • Ability to work independently and within a highly collaborative team environment

  • Ability to adapt to change

Leadership Behaviors

  • Continuously strives to achieve superior results

  • Expresses oneself in a confident and trustworthy manner

  • Demonstrates a sense of urgency in a fast-paced work environment

-Demonstrates the ability to adapt to change

Position Qualifications

  • 4-year college degree preferred or equivalent work/education experience

  • Minimum 1-2 years of disability claim / case management, or other previous group insurance experience preferred

  • Group Disability claim experience or product knowledge strongly preferred

  • Understanding of medical terminology and medical conditions helpful

  • Regulatory and Compliance experience a plus

  • Strong Microsoft Word and Excel

Travel

Very minimal travel.

Salary Range

$40,160.00 - $60,237.50

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

Justice, Equity, Diversity & Inclusion (J.E.D.I.)

  • Employee Resource Groups that advocate for inclusion and diversity

  • J.E.D.I. certification and training programs

  • Matching gifts/volunteering

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 .

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