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New York Life Insurance Company · 5 days ago

LTD (Long Term Disability) Claim Manager

United States

Full-time

Remote

Mid Level

$50K/yr - $72K/yr

3+ years exp

New York Life Insurance Company is dedicated to providing financial security and peace of mind through its comprehensive insurance solutions. The LTD Claim Manager will manage a caseload of Long-Term Disability claims, ensuring effective communication with customers and stakeholders while developing strategic case plans and making informed claim decisions.

FinanceFinancial ServicesInsurance

Responsibilities

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

Qualification

Long-Term Disability managementCustomer communicationClaim decision makingMS Office proficiencyCritical thinkingAnalytical skillsOrganizational skillsTime managementCustomer focusFeedback skills