FML Claims Case Manager I

 Position Summary

Our 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. The FML Leave manager is responsible for proactively managing Leave of Absence programs and individual FML cases based on plan provisions, state and federal guidelines, and established protocols.

You will

·       Interact and consult with key partners including Clients, Claimants, Nurse and Disability Case Managers, Risk Management.

·       Administer 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.

·       Utilize problem solving, analytical, written, and verbal communication skills to deliver timely and appropriate leaves management decisions while providing superior customer service to all internal and external customers.

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

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

·       Make recommendations for second and third opinions, independently and when indicated and concurred with by the Manager.

·       Maintain FML and absence information in Absence Manager Software System, including comprehensive activity notes.

·       Provide reports detailing essential information on open and closed absences.

·       Manage intermittent occurrences in accordance with approved certifications and identifies trends or abuse patterns.

·       Identifies potentially fraudulent cases.

·       Communicate with claimants, plan holders, and physicians as needed for information needed for initial and ongoing leave management.

You have

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

·       Minimum 1-4 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.

·       Bi-Lingual a plus

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

·       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

Salary Range:

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. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits. 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.

Accommodations

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 [email protected].

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.