Appeals Case Manager II

Overview

This role is an Appeals Case Manager II (ACM 2) on the Appeals Team, responsible for adjudicating assigned appeals for Group Life and Disability claims. The position conducts a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations.

The role supports Group Short-Term Disability, Long-Term Disability, and Life Waiver of Premium appeals.

Responsibilities

• Plan, implement, and execute investigation of disputed claims to ensure timely and compliant appeal resolution.
• Identify and interpret relevant plan language and thoroughly investigate claim issues to make an accurate, non-biased appeal determination.
• Evaluate medical, financial, and other claim information in consultation with clinical/vocational professionals to resolve disputes.
• Provide proactive outreach to deliver superior customer service to internal and external customers.
• Identify legal and/or compliance scenarios requiring additional research and facilitate resolution.
• Maintain current knowledge of ERISA and Department of Labor guidelines.
• Independently prioritize workload based on individual and departmental deadlines.
• Share insights and learnings with claims colleagues.

Required Qualifications

• High School Diploma or GED required.
• Minimum of 5 years of Group Disability and/or Life Claims experience.
• Strong client focus with excellent verbal and written communication skills.
• Demonstrated problem-solving, analytical, mathematical, and research skills.
• Ability to manage multiple priorities and tasks while ensuring compliance with applicable regulatory requirements.
• Flexibility and adaptability in response to changing business needs.

Preferred Qualifications

• Minimum of 3 years of experience handling appeals and/or complex claims.
• Bachelor’s degree or equivalent combination of education and professional experience.

Location & Travel

• Mobile position with preference for candidates within commuting proximity to a company office, with the ability to travel to company offices as determined by the People Leader.
• Occasional travel: 0–10%.

Compensation & Benefits

• Salary range: $58,620.00 - $96,300.00 (base pay for the primary location).
• Base pay is determined based on education, experience, knowledge, and abilities of the successful candidate.
• In addition to salary, this role may be eligible for annual, sales, or other incentive compensation.
• Eligible benefits (for full-time employees): medical, dental, supplemental health, life, and vision coverage for you and your dependents with no wait period; life and disability insurance; 401(k) with company match; tuition assistance; paid parental leave and backup family care; flexible time off and work location policies; employee resource groups.

Additional Information

• Reporting: Appeals Case Manager II reports to the Leader – Appeals Team, who reports to the Leader – Group Claims Appeals & Compliance.

• Work authorization: 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.

• Equal Employment Opportunity and accommodations are provided in accordance with applicable law.