Disability Claims Examiner - Stable & Mature Claims

Location Designation: Hybrid - 6 days per month 

Work Schedule and Location: This is a hybrid position based out of our White Plains, NY office. Team members are expected to work onsite one day per week (Wednesdays), with one additional onsite day per month for team meetings or business activities.  

Business Unit Overview:

As part of New York Life’s Group Membership Association Division, you'll be working with the nation’s No. 1 provider of life and disability income insurance solutions for association/affinity programs. Beyond the tailored life and disability income insurance solutions you provide, your work fosters a sense of community and shared support within affinity groups.

Role Overview:

New York Life is seeking a Disability Claims Examiner to support our Stable & Mature (SAM) Long Term Disability claim portfolio. This role is responsible for administering established disability claims that require ongoing certification, benefit maintenance, documentation review, and customer support.

The successful candidate will manage a caseload of long-duration disability claims, review medical and claim documentation, ensure continued eligibility for benefits, and maintain accurate claim records in accordance with company policies and procedures. The position requires strong organizational skills, attention to detail, sound judgment, and a commitment to delivering exceptional customer service.

The Stable & Mature Examiner serves a critical role in ensuring ongoing disability claims remain properly supported, accurately administered, and responsive to customer needs while maintaining operational excellence and compliance standards. This position provides an opportunity to develop deep expertise in disability claims management while making a meaningful impact on customers who rely on their benefits.

This position is expected to provide operational support to the DI Claims department by administering HIP (Hospital Indemnity) and Rabies claims as needed.  The role also provides primary phone support to the DI department.  The SAM Examiner is also expected to provide backup coverage to the department admin in the creation of new claims and the scanning of documents.

What You’ll Do:

Claim Management

• Manage an assigned inventory of Stable & Mature Long Term Disability claims.
• Conduct annual disability certification reviews and related follow-up activities.
• Review Medical Physician Statements (MPS), medical updates, and supporting claim documentation.
• Determine whether established disability claims continue to meet eligibility requirements.
• Maintain accurate and complete claim documentation and file records.
• Ensure claim activities are documented timely and in accordance with departmental standards.

Benefit Administration

• Monitor certification due dates, benefit milestones, and follow-up requirements.
• Maintain reminders, diary dates, and claim action items.
• Verify claim coding, benefit information, and supporting documentation.
• Process benefit continuation and claim closure activities when appropriate.
• Ensure claims remain compliant with policy provisions and claim management requirements.

Medical Documentation Review

• Identify gaps, inconsistencies, or material changes in claim information and determine the additional documentation or follow-up required.
• Review functional information and identify material changes in a claimant's condition.
• Obtain additional documentation when required.
• Coordinate referrals for medical review in accordance with established procedures.

Customer Service

• Serve as the primary point of contact for assigned claimants.
• Communicate complex or sensitive claim information clearly and professionally to claimants, physicians, employers, and internal business partners.
• Respond to inquiries regarding claim status, documentation needs, and benefit administration.
• Deliver a positive customer experience through timely, accurate, and empathetic service.
• Provide backup phone coverage for examiners within the DI Claims Department.

Quality and Compliance

• Maintain compliance with company policies, procedures, and regulatory requirements.
• Support quality review and audit activities.
• Contribute to process improvement initiatives that enhance efficiency, accuracy, and customer experience.
• Demonstrate accountability for claim quality, timeliness, and service outcomes.

What You’ll Bring:

Required

• Prior experience in insurance, claims administration, disability benefits, healthcare operations, financial services, or a related customer service environment.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Demonstrated attention to detail and accuracy.

Preferred

• Bachelor’s Degree.
• Experience reviewing medical documentation and records.
• Knowledge of disability claim administration and benefit provisions.
• Experience working with claims management or workflow systems.

Pay Transparency

Salary Range: $58,000-$70,000 

Overtime eligible: Nonexempt 

Discretionary bonus eligible: Yes 

Sales bonus eligible: No 

Actual base salary will be determined based on several factors but not limited to individual’s experience, skills, qualifications, and job location. Additionally, employees are eligible for an annual discretionary bonus. In addition to base salary, employees may also be eligible to participate in an incentive program.

Our Benefits

We provide a full package of benefits for employees – and have unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs. Based on feedback from our employees, we continue to refine and add benefits to our offering, so that you can flourish both inside and outside of work. Click here to discover more about our comprehensive benefit options or visit our NYL Benefits Site.

Our Commitment to Inclusion
At New York Life, fostering an inclusive workplace is fundamental to who we are and how we serve our communities. We have a longstanding commitment to creating an environment where individuals can contribute their best and succeed together. This foundation is rooted in our core values of humanity and integrity, ensuring that every employee feels valued and supported. By embracing a broad range of perspectives and experiences, we achieve greater success and fulfill our promise of providing financial security and peace of mind to families across all communities. Click here to learn more about New York Life’s leadership in this space.​

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. To learn more about career opportunities at New York Life, please visit the Careers page of www.NewYorkLife.com.

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Job Requisition ID: 94801