STD/Absence Claims Case Manager I

The STD/Absence Claims Case Manager I (CM) is responsible for adjudicating and medically managing Short Term and Absence claims involving 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, including Family and Medical Leave Act (FMLA), State Paid Medical Leave, and/or State Paid Disability. The CM will manage the claim according to the plan provisions, state and federal guidelines, and established protocols. This role requires sound judgment, critical thinking, and problem-solving skills to work independently, interpret contract provisions, analyze medical and claim information, and administer benefits through the appropriate claim duration or return to work. The CM is responsible for meeting key service deliverables such as turnaround times, quality assurance, and overall customer experience.

This position utilizes analytical reasoning, problem solving, adaptability, and strong written and verbal communication skills to ensure timely and appropriate absence and disability claim decisions while providing superior customer service to all internal and external customers. This position requires consistent and effective claim management skills, resilience in a fast-paced environment, and the ability to adapt as claim circumstances, priorities, or information change.

Candidate Responsibilities

• Effectively understand contract language and plan design for group disability
• Communicate claim status and decisions via telephone and in writing 
• Initiate communications to claimant, physician, and planholder to assess and facilitate job accommodation opportunities
• Proactive outreaches to claimants, planholders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. current earnings, other income benefits, medical information, etc.); notifies claimants when claims are pended for missing information
• Proactively identify claim issues, develop and execute a well-reasoned plan of action for pending and ongoing disability claims, and adjust strategies as new information becomes available. Utilize, manage, and direct appropriate resources to support timely and accurate benefit determination for internal and external customers in accordance with policy provisions, regulatory requirements, internal standards, and customer service expectations.
• Apply critical thinking to investigate, analyze, and synthesize claim information, contract provisions, medical documentation, and regulatory requirements to determine coverage, benefit eligibility, and appropriate claim outcomes.
• Demonstrate adaptability and resilience by effectively managing shifting priorities, changing claim circumstances, and time-sensitive decisions in a fast-paced environment.
• Determine if claimants meet the definition of disability as defined in the contract by reviewing occupational requirements, analyzing medical information, identifying gaps or inconsistencies, and applying sound judgment to reach appropriate claim decisions.
• Review, validate, and refine AI-generated claim recommendations, data extractions, and draft correspondence, applying professional judgment before finalizing decisions or communications.
• Verify the accuracy and completeness of AI-assembled claim files and AI-flagged discrepancies, ensuring quality, regulatory compliance, and audit-readiness of claim documentation.
• Establish, document and execute claim action plan and recommended path including return to active work at claimant’s own job
• Determine Insured Earnings by reviewing payroll information from the planholder and calculate payable benefits according to plan provisions, with strong attention to accuracy, detail, and applicable offsets.
• Follow all claim management procedures and facilitate potential return to work and job accommodation opportunities when applicable
• Utilize claim management resources such as MDA (Medical Disability Guidelines) and other disability tools to assist with appropriate durational disability
• Assess claim when other sources of income are received (e.g., social security, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits, as needed, to determine under/overpayments.   Proactively work with claimants to recover overpayments in full or negotiate monthly installments according to established protocols
• Assess claim for restrictions and limitations to establish appropriate partnership with PRT
• Remain composed, resourceful, and solutions-oriented when resolving routine claim challenges, addressing missing information, and determining appropriate next steps.

Reporting Relationship: This position reports to a Team Leader, STD/Absence.

Functional Skills

• Outstanding customer service
• Strong critical thinking, analytical reasoning, and information ability to assess claim, medical, payroll, and contract information accurately.
• Ability to identify issues, evaluate options, and determine appropriate next steps with accuracy, timeliness, and customer focus
• Strong math aptitude
• Ability to manage multiple priorities and meet departmental turnaround times
• Demonstrated independent problem solving, sound judgment, and decision-making ability within established procedures and service expectationAbility to clearly communicate claim decisions and contract language verbally and in written correspondence
• Ability to multi-task, balance goals, prioritize effectively, and adapt to shifting business or claim priorities
• Resilience and adaptability in a high-volume, fast-paced claim environment
• 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) with AI/Co-Pilot Prompting Skills preferred
• Effective and efficient time management
• Ability to review and validate AI-generated recommendations, extractions, and correspondence, exercising sound judgment on when to accept, adjust, or override AI output
• Data quality assurance and attention to detail, including verifying completeness, accuracy, compliance, and audit-readiness of claim files

Leadership Behaviors

• Demonstrates sound judgment, thoughtful decision-making, and a commitment to achieving superior results
• Expresses oneself in a confident and trustworthy manner
• Demonstrates a sense of urgency while maintaining accuracy, composure, and quality in a fast-paced work environment
• Adapts quickly to change, remains resilient when priorities shift, and approaches challenges with a solutions-oriented mindset
• Uses curiosity, resourcefulness, and critical thinking to address issues and support positive claim outcomes

Position Qualifications

Required

• Bachelor’s degree preferred
• Strong math aptitude, including the ability to calculate benefits and review payroll or income information accurately
• Demonstrated ability to use critical thinking, problem solving, and sound judgment to evaluate information and determine appropriate next steps.
• Ability to prioritize and multi-task while navigating through multiple business applications, adapting to changing priorities, and remaining resilient in a fast-paced environment.
• Ability to work independently within established procedures while providing exceptional customer service through clear and professional communication
• Successful completion of a job-related assessment is required.

Preferred

• Group Benefits experience. Short Term Disability, Statutory Paid Leave, Family Medical Leave, adjacent insurance industry experience, regulatory and compliance or other professional equivalent experience.
• Strong skillset in Microsoft Windows applications, including Microsoft Word, Excel, and Outlook; AI/Copilot prompting skills

Travel

• Very minimal travel, only as needed

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 MyHR@glic.com. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (“AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to MyHR@glic.com, making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via MyHR@glic.com.

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here. 

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