When you join New York Life, you’re joining a company that values career development, collaboration, innovation, and inclusiveness. We want employees to feel proud about being part of a company that is committed to doing the right thing. You’ll have the opportunity to grow your career while developing personally and professionally through various resources and programs. New York Life is a relationship-based company and appreciates how both virtual and in-person interactions support our culture.
The LTD Claim Manager will manage an assigned caseload of Long Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim.
As a Long-Term Disability Claims Examiner, you will:
Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block.
Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint
Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact
Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach.
Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies
Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Execute on all client performance guarantees
Respond to all communications within customer service protocols in a clear, concise and timely manner
Make fair, accurate, timely, and quality claim decisions
Adhere to standard timeframes for processing mail, tasks and outliers
Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated
Personal Health Team, Your Health First, Healthcare Connect, etc.)
Clearly articulate claim decisions both verbally and in written communications
Understand Corporate Compliance, Policies and Procedures and best practices
Stay abreast of ongoing trainings associated with role and business unit objectives
Qualifications
High School Diploma or GED required. Bachelor's degree strongly preferred.
Long Term Disability Claims experience preferred.
Experience in hospital administration, medical office management, financial services and/ or business operations is a (+)
Comfortable talking with customers and having thorough phone conversations.
Excellent organizational and time management skills.
Strong critical thinker.
Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
Ability to focus and excel at quality production
Proficiency with MS Office applications is required (Word, Outlook, Excel).
Strong written and verbal skills demonstrated in previous work experience.
Specific experience with collaborative negotiations.
Proven skills in positive and effective interaction with customers.
Experience in effectively meeting/exceeding personal professional expectations and team goals.
Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
Comfortable giving and receiving feedback.
Flexible to change.
Demonstrated analytical and math skills.
Critical Competencies:
Decision Quality
Communicate Effectively
Action Oriented
Manages Ambiguity
Customer Focus
Position may be a CS3 or CS4 depending on the prior experience of the candidate.
Technology Requirements:
Functioning broadband (cable/DSL) should meet the following minimum requirements 50mb download/20mb upload speed
Ability to hardwire into internet connection
It is recommended that all qualified candidates apply to this posting as soon as possible. Residents of Colorado are hereby notified that the deadline to apply is 6 months from the Posting Date listed above.
Salary range: $42,500-$70,000
Overtime eligible: Nonexempt
Discretionary bonus eligible: Yes
Sales bonus eligible: No
Click here to learn more about our benefits . Starting salary is dependent upon several factors including previous work experience, specific industry experience, and/or skills required.
Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by the Foundation . We're proud that due to our mutuality, we operate in the best interests of our policy owners. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn , our Newsroom and the Careers page of www.NewYorkLife.com .
Job Requisition ID: 89590
Seniority level
Not Applicable
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance and Financial Services
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