Claims Case Manager II, Supplemental Health Job at Guardian Life, Dover, DE

  • Guardian Life
  • Dover, DE

Job Description

at Guardian Life in Dover, Delaware, 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 years processing Supplemental Health claims. (Accident, Critical Illness, Cancer and Hospital Indemnity)

+ Knowledge of Supplemental Health products, administration, and claims procedures.

+ Claim processing experience preferred or working knowledge of claims processes.

+ Excellent PC skills with knowledge of MS Word/Excel/ PPT .

+ Bachelor’s Degree or equivalent work experience required.

+ Ability to problem solve systematic issues or changes based on standard and non-standard administration of claim benefits.

+ Agility in handling multiple tasks, responding rapidly to changing priorities, and working with tight deadlines.

+ Ability to keep the Voice of the Customer ( VOC ) forefront by demonstrating a proactive approach to problem solving or looking at continuous improvement.

+ Excellent decision making and communication skills.


Flexible – Will consider remote candidates if experience is aligned and ability to travel to Guardian offices as required, determined by the People Leader. Preference given to candidates within commuting proximity to a Guardian Office which include:

+ Bethlehem, PA

+ Hudson Yards, New York City

+ Holmdel, NJ

+ Pittsfield, MA

Salary Range

$48,190.00 – $72,280.00

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

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 .

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 .

To view full details and how to apply, please login or create a Job Seeker account

Job Tags

Holiday work, Full time, Work experience placement, Remote job, Flexible hours,

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