Claims Representative - Long Term Disability

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Date: Jan 5, 2021

Location: Pittsburgh, PA, US

Company: New York Life Insurance Co

A career at New York Life offers many opportunities. To be part of a growing and successful business. To reach your full potential, whatever your specialty. Above all, to make a difference in the world by helping people achieve financial security. It’s a career journey you can be proud of, and you’ll find plenty of support along the way. Our development programs range from skill-building to management training, and we value our diverse and inclusive workplace where all voices can be heard. 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 service, supported by our Foundation. It all adds up to a rewarding career at a company where doing right by our customers is part of who we are, as a mutual company without outside shareholders. 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.

 

Role Description:
The Group Claims Representative will manage an assigned caseload of more complex Long-Term Disability cases. This includes management of claims with longer duration and evolving medical conditions.  It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate claimant eligibility and interact with internal and external customers including, but not limited to, claimants, 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 Representative, you will:

  • Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented 
  • Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Pay all covered claims accurately and timely
  • Execute on all customer performance guarantees              
  • Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner 
  • Manage both new claims and open claims equally and maintains decision times
  • Adhere to standard time frames 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.)
  • Understand Group Operations and 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
  • 1 year minimum of professional experience is strongly preferred
  • Experience in hospital administration, medical office management, financial services and/ or business operations  is a (+)
  • Excellent organizational and time management skills
  • Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
  • Proficiency with MS Office applications is required (Word, Outlook)
  • Strong written and communication skills demonstrated in previous work experience
  • Specific experience with collaborative negotiations
  • Proven skills in positive and effective interaction with challenging customers
  • Experience in effectively meeting/exceeding individual 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
  • Demonstrated analytical and math skills

 

NOTE: We are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connection.  A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current set up.

 

EOE M/F/D/V

 

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SF:LI-MC1

Job Requisition ID: 83050 


Nearest Major Market: Pittsburgh

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