Team Leader, LTD Claims Case Management

As the Team Leader, LTD Claims Case Management, you will be responsible for validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. You will manage and resolve issues pertaining to claim administration, cost containment, reports, and quality control. Serving as the primary resource, you will provide direction to staff, set objectives, communicate goals, and ensure adherence to quality assurance and efficiency standards. You will also assist with career development and partner with cross-functional areas for program direction and service delivery.

Must Have

• Validate LTD claims accurately and fairly adjudicated according to plan provisions, best practices, and state/federal guidelines
• Manage and resolve issues pertaining to claim administration procedures, cost containment, reports, and quality control
• Serve as primary resource for the team and provide direction to staff members
• Set objectives, communicate progress and goals, and hold staff accountable for quality assurance, turnaround times, and efficiency
• Assist staff with career development and career progression
• Partner with internal cross-functional areas for program direction, goal setting, and service delivery
• Work with external customers to enhance overall experience
• Develop employee goals to promote career growth
• Cross collaboration with business partners including Life and Disability, CRU, SIU, Sales Force, Group Quality Management
• Promote leadership model to support Guardian values
• Develop and communicate objectives and performance goals for the department
• Manage direct report’s performance by coordinating with HR business partners
• Create yearly action plan based on employee engagement survey results
• Review daily, weekly and monthly reports on team productivity for operational reporting and monitoring
• Coordinate and monitor overpayment recovery efforts, vendor/legal negotiations and tracking
• Monitor claim turnaround times to validate decisions are made within DOL and policy time frames
• Oversee settlement checks in accordance with settlement agreements
• Assist in self-testing for MARs Financial Control
• Develop training tools in conjunction with technical experts
• Empower staff through brainstorming sessions to revise workflows and procedures
• Support strategic initiatives from a Life/DI claim perspective
• Prepare agenda, schedule and facilitate team meetings
• Mentor, coach, supervise and develop talent of direct reports
• Review claim staff QA assessments for training or enhancement opportunities
• Identify Continuous Improvement opportunities by reviewing process
• Validate refund and returned checks are processed accurately and timely
• Assist manager with departmental budget and vendor expenses
• Identify claim success stories that promote Guardian’s value proposition
• Minimum of 5 years of LTD claims experience
• Bachelor’s Degree in related field and/or equivalent relevant disability work experience
• Previous leadership experience in decision making, trouble shooting, staff development, and related skills and abilities
• Excellent organizational and time management skills
• Excellent math aptitude and analytical skills
• Professional oral, written and presentation skills
• Strong PC skills, including Microsoft Office applications
• Extensive knowledge of Guardian’s disability products, business rules and procedures
• Familiarity with mandated state and federal regulations

Good to Have

• DCMS claim system knowledge

Perks & Benefits

• Support and flexibility to achieve professional and personal goals
• Skill-building opportunities
• Leadership development opportunities
• Philanthropic opportunities
• Opportunities to build communities
• Contemporary, supportive, flexible, and inclusive benefits and resources

As the Team Leader, LTD Claims Case Management, you will be responsible for validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. As the Team Leader you must be able to manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues. You will serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency. You are also responsible for assisting staff with career development and career progression. The Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. You will also work with external customers to enhance the overall experience for the customer. The Team Leader is responsible for the overall functioning of the department.

You are

• A true leader who fosters a culture where diverse thoughts, experiences, and backgrounds are valued and celebrated
• Empowering to employees to take the initiative to further team and company goals and encourage candor and transparency
• able to create a safe environment to try new ideas and make mistakes and able to demonstrate the courage to make difficult decisions and have candid conversations
• Able to demonstrate a high performance standard for employees and team
• Balances risk with growth opportunities
• Able to maintain a strong external focus, voice of customer, industry and regulatory
• Strategically aligned to processes and resources for future goals and objectives

You will

Manage People 40%

• Develop employee goals to promote career growth that enhance level of knowledge for future opportunities
• Cross collaboration with business partners including Life and Disability, CRU, SIU, Sales Force, Group Quality Management and other areas within the company
• Promote leadership model to support Guardian values
• Develop and communicate objectives and performance goals for the department
• Managing direct report’s performance by coordinating with HR business partners to develop coaching plans and performance improvement plans
• Create yearly action plan based on the results from the employee engagement survey

Manage Risk 30%

• Based on feedback from technical consultant review daily, weekly and monthly reports on team productivity 1) for operational reporting and monitoring purposes; and 2) to identify trends and training opportunities
• Coordinate and monitor overpayment recovery efforts, vendor/legal negotiations and tracking for liability and reporting purposes
• Monitor claim turnaround times to validate decisions are made within DOL and policy time frames
• Oversee settlement checks in accordance with settlement agreements
• Assist in self-testing for MARs Financial Control

Train and Develop 20%

• Develop training tools in conjunction with technical experts to deliver training to the staff
• Empower staff through brainstorming sessions to revise workflows and procedures that promote best practices
• Support strategic initiatives from a Life/DI claim perspective with contract rewrites and related projects
• Prepare agenda, schedule and facilitate team meetings
• Mentor, coach, supervise and develop talent of direct reports by recommending and coordinating training plans for individuals to exceed personal and departmental goals and objectives
• Review claim staff QA assessments for training or enhancement opportunities

Manage Processes 10%

• Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps
• Validate refund and returned checks are processed in an accurate and timely manner and in accordance to departmental policy
• Assist manager with departmental budget and vendor expenses
• Identify claim success stories that promote Guardian’s value proposition

You have

• Minimum of 5 years of LTD claims experience
• Bachelor’s Degree in related field and/or equivalent relevant disability work experience
• Previous leadership experience in decision making, trouble shooting, staff development, and related skills and abilities
• Excellent organizational and time management skills
• Excellent math aptitude and analytical skills
• Professional oral, written and presentation skills
• Strong PC skills, including Microsoft Office applications
• Extensive knowledge of Guardian’s disability products, business rules and procedures
• DCMS claim system knowledge a plus
• Familiarity with mandated state and federal regulations

Travel and Office Model

• This is a fully remote role with possible minimal travel to other locations and conferences

Salary Range:

$58,620.00 - $96,300.00

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. 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 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.

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