Candidate selected to fill this position must have a permanent living address within the state of Georgia. The employee's telecommuting work location will be within a designated and approved workspace at the employee's home address. General Definition of Work Performs skilled technical work managing and resolving assigned lost time and complex medical only claims on behalf of the Association's insurance programs to ensure prompt determination of compensability, payment of entitled benefits, litigation management and effective claim resolution, and related work as apparent or assigned. Work is performed under the supervision of the Claims Supervisor. Qualification Requirements To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions. Position Responsibilities - Supports the Association through the support of division or program staff and interaction with local governments and authorities; exhibits knowledge and general understanding of the programs and services offered by the Association, and provides outstanding customer support that reflects well on the entire Association. - Initiates initial investigation for newly assigned insurance claims; confirms coverage of claim, contacts member, member representative, non-represented claimants, claimant's attorney and/or injured employees to obtain/provide information. - Initiates compensability and/or liability determination through completion of statements, recorded statements, on-site investigations. - Sets initial reserves for claims; performs proper and timely reserve evaluations and adjustments; reviews and approves bills for processing; reviews medical/rehabilitation notes; reviews and signs off daily check sheet; prepares and submits reports to excess carriers when loss is greater than one-half retention level. - Establishes and maintains proper claim diary requirements of existing caseloads with documentation of action plans; ensures action plans are adhered to in a timely manner. - Receives and responds to inquiries and requests for information from members, injured employees, vendors, case managers, legal representatives and medical providers. - Completes Electronic Data Interchange (EDI) transmissions, state board filings and completes Centers for Medicare Services (CMS) requirements. - Utilizes cost control measures regarding claims management when applicable including One Call Medical, Align, Telephonic Case Manager (TCM), Field Case Manager (FCM) and Surveillance; works at eliminating the payment of fines and penalties due to late and/or form filings. - Occasional overnight travel required – less than 20 days per year – i.e. travel to mediations, hearings, depositions, account/member visits, and seminars. Knowledge, Skills and Abilities - Thorough knowledge of business English, spelling and arithmetic, standard office practices, procedures, equipment and administrative support techniques; - Thorough knowledge of the workers' compensation system requirements and medical only claim administration; - General knowledge of the laws, legal codes, court procedures, precedents, government regulations and agency rules regulating the workers compensation insurance industries; ability to make arithmetical calculations; ability to operate a variety of standard office equipment including personal computer and associated software; - Ability to communicate ideas effectively in both oral and written formats; ability to type accurately at a reasonable rate of speed; ability to follow oral and written instructions; ability to read and understand detailed and complicated policies, procedures and materials that contain specialized words and phrases; - Ability to establish and maintain effective working relationships with associates, claimants, attorneys, Nurse Case Managers, physicians, local government officials, customers and the general public. Education and Experience - Bachelor's degree with coursework in business administration, insurance, or related field and - Moderate (1 – 3 years) of related experience in workers' compensation claim administration, or - Equivalent combination of education and experience. - AIC, ARM, and/or CPCU Professional Designations desired Physical Requirements - This work requires the occasional exertion of up to 10 pounds of force; - Work regularly requires sitting, speaking or hearing, using hands to finger, handle or feel and reaching with hands and arms and occasionally requires standing, walking, climbing or balancing, stooping, kneeling, crouching or crawling, pushing or pulling, lifting and repetitive motions; - Work has standard vision requirements; vocal communication is required for expressing or exchanging ideas by means of the spoken word; hearing is required to perceive information at normal spoken word levels; - Work requires preparing and analyzing written or computer data, operating motor vehicles or equipment and observing general surroundings and activities; - Requires light physical effort working almost exclusively with light weight materials (up to 25 pounds) or short periods in difficult work positions. - Working conditions with absence of disagreeable conditions and little or no accident or health hazards; considerable mental effort and stress involved which could result in tension or anxiety. Special Requirements - Employee is required to have and maintain a high-speed, broadband internet connection at their work site that is sufficient to enable fast, consistent service to the membership. A minimum download speed of 25 Mbps is required. To ensure a consistent speed at this level, a 40MB internet connection is recommended. You may check your download speed at speedtest.net. - Possession of or ability to acquire a Georgia Adjusters License issued through the State of Georgia Insurance Department within one year of employment. - Valid driver's license in the State of Georgia. Notice: ACCG employees must have a primary residence within the state of Georgia. In addition, employment candidates are subject to a background screening in compliance with established ACCG background check procedures.

Role Description This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility. - Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination. - In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider. - Effectively communicate, verbal and written, all aspects of the claim benefit determination process. - Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider. - Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately. - Attend case conferences, internally and with the client, to present claims recommendations. - Meet quality and production metrics as established and communicated by the department. - Other duties as assigned. Qualifications - Associates Degree or equivalent formal training program, or 2 years experience in a medical or insurance environment. - At least 3 years work experience with claims and insurance contract interpretation. - Intermediate level experience with Microsoft Office products. Requirements - Experience working with healthcare, long-term disability or long term care claims. - Familiarity with nursing home and home care service providers and service delivery settings. - Excellent verbal and written communication skills. Benefits - The base pay for this position is starting at $24/hour depending on experience and qualifications.

This is a mobile position with preference given to candidates within commuting proximity to a Guardian office with the ability to travel to Guardian offices as determined by the People Leader. Position Summary The Life Team Leader is responsible for validating that all Life claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. The Team Leader must be able to manage and resolve issues that pertain to claim administration procedures cost containment activities, reports, and quality control issues. The Team Leader 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 will assist team members with their development and career progression. The Team Leader partners internally with cross-functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. The Team Leader works with external customers to enhance the overall experience for the customer. You will be responsible for the overall functioning of the department. Qualifications - 4 year college degree preferred or equivalent work/education experience - Minimum 3 years life claims experience - Previous people leadership experience strongly preferred - Regulatory and Compliance experience a plus Functional Skills - Excellent written and verbal communication skills - Ability to exercise independent & sound judgment in decision making - Able to hold others accountable - Ability to analyze evidence for discrepancies - Ability to conduct research using multiple techniques - Excellent time management & organizational skills - Multitasking with the ability to manage continually changing priorities and ability to prioritize work based on customer service needs and departmental regulations - Self-motivated & able to work independently - Ability to work collaboratively with multiple professional disciplines and with diverse population Leadership Behaviors - Actively coaches, develops and rewards team members - Builds teams to ensure the very best people are in place - Trusts the team to get the job done - Fosters a culture where diverse thoughts, experiences, and backgrounds are valued and celebrated - Empowers employees to take the initiative to further team and company goals - Creates a safe environment to try new ideas and make mistakes - Demonstrates the courage to make difficult decisions and have candid conversations - Encourages candor and transparency - Communicates the business need for change - Leads effectively in ambiguous environments - Sets high performance standards for employees and team - Builds commitment to achieve goals and deliverables - Balances risk with growth opportunities - Maintains a strong external focus, voice of customer, industry and regulatory - Strategically aligns processes and resources to future goals and objectives - feedback Partnering Ability to work with colleagues from other teams and/or business units to ensure appropriate claim outcomes. Reporting Relationships This position reports to the Manager, Life & Supplemental Health Claims who in turn reports to the Head of LTD, Life & Supplemental Health Claims. Location: Remote/Flexible – work from home. May be expected to come into a Guardian work location occasionally, as determined by their people leader. 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.

• To analyze mid- and higher-level workers compensation claims to determine benefits due. • To ensure ongoing adjudication of claims within company standards and industry best practices. • To identify subrogation of claims and negotiate settlements. • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. • Manages subrogation of claims and negotiates settlements. • Communicates claim action with claimant and client.