LTD (Long Term Disability) Claim Manager

New York Life Insurance Co.; New York (NY); Remote; USD 50,000 - 72,000; Full time

Benefits offered by this job

Leave programs

Adoption assistance

Student loan repayment

Job summary

New York Life's Group Benefit Solutions is seeking a LTD Claim Manager to oversee long-term disability caseload, develop strategic case plans, and collaborate with team leaders and medical partners to reach informed decisions. You will manage an assigned caseload of long-term disability cases, partnering with leaders and coaches for guidance, and ensuring accurate monthly benefit calculations.

You will interact with customers, employers, physicians and other stakeholders to gather information

Qualifications

• Comfortable talking with customers on the phone.
• Strong organizational and time management skills.
• Proficiency with MS Office applications.

Responsibilities

• Proactively manage your block of claims by regularly talking with customers and understanding case facts.
• Develop and document strategic case plans.
• Determine customer eligibility by reviewing contractual language and medical documentation.
• Communicate claim decisions clearly to customers and employers.

Skills

Customer communication

Time management

MS Office

Analytical thinking

Organizational skills

Self-starter

Education

High School Diploma or GED

Bachelor's degree preferred

Tools

MS Office (Word, Outlook, Excel)

Job description

Location Designation: Fully Remote

Group Benefit Solutions delivers comprehensive insurance and absence management solutions for mid-sized and large companies. Our work fosters a healthier, happier, and more secure workforce, contributing to New York Life’s legacy of being there when we’re needed most. Here, you’ll design, implement, and support these solutions directly impacting employees’ lives. At our core, we provide financial security and peace of mind to people through our absence, accident, disability, voluntary benefits, and life insurance solutions. Click here to learn more about Group Benefits solutions.

Role Overview

The LTD Claim Manager is responsible for accomplishing training requirements, learning, and applying the LTD concepts gained in classroom and on the job training to successfully manage an assigned LTD caseload. The Claim Manager is responsible for the development of strategic case plans informed by customer & key stakeholder interactions, leveraging Technical Coaches and Team Leaders where appropriate. As a key customer-facing role, the Claim Manager will communicate with customers, employers and treating providers.

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 partner with Team Leaders and Technical Coaches for guidance on having meaningful and transparent conversations with their customers and clinical partners to gather the information most relevant to each claim. It also requires potentially complex monthly benefit calculations, which will be reviewed for accuracy. The Claim Manager 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.

What You'll Do:

• 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.
• 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 probing conversations 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) to question discrepancies, close gaps and clarify inconsistencies.
• Have detailed phone conversations 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.

What You’ll Bring:

• High School Diploma or GED required, with 3 years minimum of professional experience or bachelor’s degree strongly 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 achieve production goals through high quality work.
• Proficiency with MS Office applications is required (Word, Outlook, Excel).
• Strong written and verbal skills demonstrated in previous work experience.
• 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 Capabilities:

• Critical Thinking
• Trust and Transparency
• Bias for Action
• Leads with Agility
• Customer Orientation

Pay Transparency

• Salary range: $50,000-$71,500
• 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.
• Actual base salary within that range will be determined by several components including but not limited to the individual's experience, skills, qualifications, and job location. 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 Diversity Promise We believe in a diverse workforce because it is our mission to advocate for the financial security and success of people in every community. This is why diversity, equity, and inclusion (DEI) are guiding principles that are embedded in our brand and our culture. Click here to learn more about how we have been recognized for our leadership.

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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