Short Term Disability/Absence Claims Case Manager I

Guardian Life Insurance

9d•Onsite

About The Position

This position is responsible for managing short-term disability and absence claims. The role involves understanding contract language, communicating claim status, assessing and facilitating job accommodation opportunities, and investigating claim information to determine coverage and eligibility. The Case Manager will establish and execute claim action plans, calculate benefits, and manage offsets from other income sources. They will also work with claimants to recover overpayments and assess claim restrictions and limitations.

Requirements

High School Diploma or GED required.
Ability to provide expectational customer service by communicating clearly and professionally.
Ability to prioritize and multi-task while navigating through multiple business applications in a fast-paced environment.
Successful completion of a job-related assessment is required.
Must be legally authorized to work in the United States, without the need for employer sponsorship.

Nice To Haves

STD, Statutory, or Family Medical Leave (FML experience preferred or other equivalent work experience.
Regulatory and Compliance experience is a plus

Responsibilities

Effectively understand contract language and plan design for group disability
Communicate claim status and decisions via telephone and in writing
Initiate communications to claimant, physician, and planholder to assess and facilitate job accommodation opportunities
Proactive outreaches to claimants, planholders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. current earnings, other income benefits, medical information, etc.); notifies claimants when claims are pended for missing information
Proactively develop and execute an appropriate plan of action for pending and ongoing disability claims assigned by utilizing, managing and directing appropriate resources.
Conduct timely and accurate benefit determination in accordance with policy provisions and regulatory and internal standards while providing sound customer service to all internal and external customers
Investigate and analyze claim information in conjunction with contract provisions to determine coverage and benefit eligibility
Recognize and adapt to fast-paced environment
Determine if claimants meet the definition of disability as defined in the contact by reviewing occupational level and analyzing medical information
Establish, document and execute claim action plan and recommended path including return to active work at claimant’s own job
Determine Insured Earnings by reviewing payroll information from the planholder; then, calculate payable benefits according to plan provisions
Follow all claim management procedures and facilitate potential return to work and job accommodation opportunities when applicable
Utilize claim management resources such as MDA (Medical Disability Guidelines) and other disability tools to assist with appropriate durational disability
Assess claim when other sources of income are received (e.g., social security, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits, as needed, to determine under/overpayments.
Proactively work with claimants to recover overpayments in full or negotiate monthly installments according to established protocols
Assess claim for restrictions and limitations to establish appropriate partnership with PRT