Job Requisition ID:91104

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.

Benefits offered:401k, Medical, Dental, Vision, Tuition Reimbursement, Student Loan Repayment

Role Overview:

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.

What You'll Do:

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

What You'll Bring:

High School Diploma or GED required. Bachelor's 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

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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Pay Transparency

Salary range:$42,500-$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.

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 theFoundation.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.

Job Requisition ID:91104