Senior Long Term Disability Claims Examiner

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Date: Oct 14, 2021

Location: Remote, SC, US

Company: New York Life Insurance Co

 

When you join New York Life, you’re joining a company that values development, career growth, collaboration, innovation, and diversity & inclusion. We want employees to feel proud about being part of a company that is committed to doing the right thing. Through various resources and programs, you can grow your career while developing personally and professionally.

GBS2021

 

 

claims, disability, long term, LTD, case manager, claims manager, claims specialist, claims representative, claims exminer, LTD claims examiner

Job Description Summary

The LTD Claim Manager is responsible for managing their assigned caseload of LTD claims with a focus on making quality decisions in a timely manner.  The claims manager is responsible for development of strategic case plans informed by customer & key stakeholder interactions.  Being a key customer-facing role, the claim manager will communicate with customers, employers and treating providers.

 

Job Description

The LTD Claim Manager will manage an assigned caseload 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.

 

This is a full time work-from-home position. Apply today!

 

As a Long Term Disability Claim Manager, 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 viewpoints
    • Determine 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 determine 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.
    • Must have 5+ years of Long Term Disability Claims Examiner experience.
    • 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 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.
    • Comfortable giving and receiving feedback.
    • Flexible to change and highly cooperative
    • Demonstrated analytical and math skills.

 

Critical Competencies:

  • Decision Quality
  • Communicate Effectively
  • Action Oriented
  • Manages Ambiguity
  • Customer Focus

 

SF:EF-LS1

 

#LI-LS1

 

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 our Foundation. 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: 84228

 

 

 


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