Claims Case Manager II, Supplemental Health - Remote - United States

Grow your career with Guardian in our newly created opportunity as a Claim Case Manager II, Supplemental Health!  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, you will be responsible for Accident, Hospital Indemnity, Cancer and Critical Illness 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 direction.

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

• Experience of 3 plus …