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Role Description

The STD/Absence Claims Case Manager I (CM) is responsible for administering and medically managing Short Term and Absence claims with specific diagnoses or leave types that tend to resolve quickly. The CM will work with employers, employees, and health care providers to administer Short Term disability in conjunction with other paid or unpaid leaves covered by Guardian.

• Manage claims according to plan provisions, state and federal guidelines, and established protocols.
• Demonstrate knowledge to work independently, interpret contract provisions, and utilize critical thinking skills for medical management.
• Meet key service deliverables such as turnaround times, quality assurance, and overall customer experience.
• Utilize problem solving and analytical, written, and verbal communication skills to ensure timely and appropriate disability claim decisions.
• Review claims for Short Term Disability and manage claims effectively in a collaborative, team-oriented culture.

Qualifications

• High School Diploma or GED required.
• STD, Statutory, or Family Medical Leave (FML) experience preferred or other equivalent work experience.
• Regulatory and Compliance experience is a plus.
• Ability to provide exceptional 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.

Requirements

• Outstanding customer service skills.
• Excellent analytics and strong math aptitude.
• Ability to manage multiple priorities and meet departmental turnaround times.
• Demonstrate independent problem solving and decision-making ability.
• Ability to clearly communicate claim decisions and contract language verbally and in written correspondence.
• Ability to multi-task, balance goals, and prioritize.
• Ability to work independently and within a highly collaborative team environment.
• Read and interpret medical information.
• Strong skillset in Microsoft Windows applications (e.g., Microsoft Word, Excel, Outlook).
• Effective and efficient time management.

Benefits

• Support and flexibility to achieve professional and personal goals.
• Opportunities for skill-building, leadership development, and philanthropic activities.
• Contemporary, supportive, flexible, and inclusive benefits and resources.

Travel

• Very minimal travel, only as needed.

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.

Visa Sponsorship

Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship.