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.
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.
This position reports to the Team Leader, Group Disability Claims, who, in turn, reports to the Manager, Group Disability Claims
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
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
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
Very minimal travel.
$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.
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.
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.
Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
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
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
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
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.
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@example.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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