$42,500-$70,000
Remote, any state, US
Fully Remote
Location Designation
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.
GBS
401k, Medical, Dental, Vision, Tuition Reimbursement, Student Loan Repayment
Benefits offered
Job Description
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 offunctioning, 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 informationand make decisions based on facts presented
- Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximumimpact
- Have discussions with customers and employers regarding return to work opportunities and communicate with anaction-oriented approach.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time ormodified 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 reviewingand 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. Bachelors 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
This position can be offered as a full-time work from home position for candidates with appropriate experience.
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.
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$42,500-$70,000
Salary range
Nonexempt
Overtime eligible
Yes
Discretionary bonus eligible
No
Sales bonus eligible
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. Starting salary is dependent upon several factors including previous work experience, specific industry experience, and/or skills required.
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Job Requisition ID89590