LTD (Long Term Disability) Claim Manager

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 OverviewThe 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 DoAs a Long-Term Disability Claim Manager, with oversight and on an increasing scheduled basis, you will -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 viewpointDetermine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presentedLeverage claim dashboard to manage claim inventory to determine which claims to focus efforts on for maximum impactHave 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 basisAsk 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 inconsistenciesHave detailed phone conversations with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical informationExecute on all client performance guaranteesRespond to all communications within customer service protocols in a clear, concise, and timely mannerMake fair, accurate, timely, and quality claim decisionsAdhere to standard timeframes for processing mail, tasks, and outliersSupport and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, IntegratedPersonal Health Team, Your Health First, Healthcare Connect, etc.)Clearly articulate claim decisions both verbally and in written communicationsUnderstand Corporate Compliance, Policies and Procedures and best practicesStay abreast of ongoing trainings associated with role and business unit objectivesWhat You'll BringHigh School Diploma or GED required, with 3 years minimum of professional experience or bachelor’s degree strongly preferredExperience in hospital administration, medical office management, financial services and/ or business operations is a (+)Comfortable talking with customers and having thorough phone conversationsExcellent organizational and time management skillsStrong critical thinkerMust be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneouslyAbility to focus and achieve production goals through high quality workProficiency with MS Office applications is required (Word, Outlook, Excel)Strong written and verbal skills demonstrated in previous work experienceProven skills in positive and effective interaction with challenging customersExperience in effectively meeting/exceeding individual professional expectations and team goalsMust have the ability to work with a sense of urgency and be a self-starter with a customer focus mindsetComfortable giving and receiving feedbackFlexible to change and highly cooperativeDemonstrated analytical and math skillsCritical CapabilitiesCritical ThinkingTrust and TransparencyBias for ActionLeads with AgilityCustomer OrientationIt 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 two weeks from the Posting Date listed above.Pay TransparencySalary range: $50,000-$71,500Overtime eligible: NonexemptDiscretionary bonus eligible: YesSales bonus eligible: NoActual 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 BenefitsWe 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.Job Requisition ID: 92810#GBS