FMLA 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
Plano TX with a hybrid environment coming into the office twice a week.
Salary Range
$40,160.00 - $60,237.50
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
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 applicant_accommodation@glic.com.
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 FMLA 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 FMLA 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.
- 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
Plano TX with a hybrid environment coming into the office twice a week.
Salary Range
$40,160.00 - $60,237.50
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 spending, health reimbursement, and health savings accounts
- Critical illness insurance
- Company-paid Life and Disability insurance plus voluntary supplemental coverage
- Accident insurance
- 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
- Complimentary 1:1 financial guidance with a licensed Fidelity representative
- Flexible work arrangements (part in-person/part remote)
- Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
- Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
- Paid parental leave and paid family and medical leave policies
- Emotional well-being, mental health, and work/life resources powered by Spring Health
- Wellness programs, including fitness program and equipment reimbursement
- Child, adult, and elder back-up care support through Bright Horizons
- Adoption assistance
- College planning
- Tuition reimbursement
- Student loan assistance
- Commuter benefits in select metropolitan areas
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 applicant_accommodation@glic.com.
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Seniority level
Entry level -
Employment type
Full-time -
Job function
Finance and Sales -
Industries
Financial Services
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