FML Claims Case Manager II

While they say the customer should always be the main focus of a service-oriented business, at Guardian, we feel our employees should also receive the same amount of attention and care. In addition to the typical benefits package that you would receive from another employer, we have gone above and beyond to show our employees they are not just another number.

At Guardian, you will also find development opportunities that will allow you to grow in your role and align with your future career intentions. This may occur via continued industry education, shadowing and project work opportunities or even by becoming a subject matter expert. We want to assure you hard work is acknowledged and appreciated.

We are looking for outgoing candidates that enjoy speaking with customers within an inbound contact center environment. Our award-winning contact center is known for delivering outstanding customer service experiences and we want to work with others that have a drive to be the best at what they do.

Position Objective : The FML Claims Case Manager II is responsible for proactively managing Leave of Absence programs and individual FML cases based on plan provisions, state and federal guidelines, and established protocols. This position interacts and consults with key partners including: Clients, Claimants, Nurse and Disability Case Managers, Risk Management. The FML Claims Case Manager II recognizes the importance of compliance and regulatory adherence, customer service, and the financial social and psychosocial implications of leave administration.

The FML Claims Case Manager II administers claims within a variety of group sizes, but is primarily assigned core and middle market cases, and is responsible for ensuring all regulations and guidelines continue to be met through the duration of the claim.

This position must utilize problem solving, analytical thinking, written and verbal communication skills to deliver timely and appropriate leaves management decisions while providing superior customer service to all internal and external customers.

Principal Accountabilities:

Case Management

• Maintains case oversight and acts as the critical communication link, in conjunction with the assigned Disability Case Manager where applicable, for all parties in FMLA client absence programs including employees, client company, health care providers and clinical partners.

• Ensures legal compliance, provides timely notifications to employees and client companies, reviews documentation for approvals and denials, responds to periodic audits.

• Makes recommendations for second and third opinions, independently and when indicated and concurred with by Manager.

• Maintains FMLA and absence information in Absence Manager Software System, including comprehensive activity notes. Provides reports detailing essential information on open and closed absences.

• Manages intermittent occurrences in accordance with approved certifications and identifies possible trends or abuse patterns.

• Identifies potentially fraudulent cases.

• Follows the designated escalation process to the Nurse Case Manager as applicable.

Communication (Verbal and Written)

• Professionally and clearly communicate claim status and decisions via telephone and in writing

• Communicate with claimants, planholders, and physicians as needed for information needed for initial and ongoing leave management

• Prepare clear and concise inquiries to clinical resources for expected scope of the medical or rehab evaluation

Partnering

• Proactively communicates with client companies to review case management and claims experience

• Consult with Risk Management area to assess functionality and return to work potential by utilizing available resources

• Perform and complete timely change in definition investigations by utilizing Risk Management and outside vendor assistance

• Partnering with Short Term Disability on large group claims for early intervention when claims are identified as having potential to transition to Long Term Disability in order to reduce potential risk

The above description includes most significant duties performed. However, other occasional work assignments not mentioned are assumed to be included. Management reserves the right to assign and/or reassign duties and responsibilities at any time.

Skills and Knowledge:

Competencies/Skills:

• Outstanding customer service skills

• Excellent analytical skills

• Demonstrate independent problem solving and decision making ability

• Ability to clearly communicate claim decisions and contract language verbally and in written correspondence

• Ability to work independently and within a highly collaborative team environment

• Ability to adapt to change

Knowledge:

• FMLA and Group Disability claim experience or group benefit product knowledge strongly preferred

• Regulatory and Compliance experience a plus

• Understanding of medical terminology and medical conditions helpful

• Strong interpersonal and PC skills (e. g. , Microsoft Word & Excel)

Education and Experience:

Education:

• 4-year college degree preferred or equivalent work/education experience

Experience:

• Minimum 1-2 years' experience working with group disability or absence management, medical disability services or similar preferred; knowledgeable of governing regulations and medical terminology.

• Previous case management, customer service or call center experience desired

Salary Range

$40,960. 00 - $61,435. 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 .