Long-Term Disability Claim Manager

New York Life•New York, NY

4d•$50,000 - $71,500•Remote

About The Position

The Long-Term Disability (LTD) Claim Manager completes required training and applies LTD concepts learned in classroom and on-the-job training to manage an assigned caseload. The role involves developing strategic case plans informed by customer and stakeholder interactions, and partnering with Team Leaders and Technical Coaches for guidance. As a customer-facing position, the Claim Manager communicates with customers, employers, treating providers, and other internal and external partners. The Claim Manager manages long-duration LTD cases involving evolving medical conditions, evaluates customer eligibility, and gathers information needed to make claim decisions. The role includes reviewing contractual language and medical documentation, handling potentially complex monthly benefit calculations, coordinating return-to-work efforts, and making fair, accurate, timely, and quality claim decisions. The position also requires meeting client performance guarantees, following customer service and processing timeframes, supporting integration initiatives, and complying with corporate policies and procedures.

Requirements

High school diploma or GED and at least 3 years of professional experience, or a bachelor's degree (strongly preferred).
Comfort communicating with customers and conducting thorough phone conversations.
Excellent organizational and time-management skills.
Strong critical-thinking skills.
Technical aptitude, including the ability to move between multiple applications and/or computer monitors simultaneously.
Ability to focus and achieve production goals through high-quality work.
Proficiency with Microsoft Office applications, including Word, Outlook, and Excel.
Strong written and verbal communication skills demonstrated in previous work experience.
Demonstrated ability to interact positively and effectively with challenging customers.
Experience meeting or exceeding individual professional expectations and team goals.
Ability to work with urgency, act as a self-starter, and maintain a customer-focused mindset.
Comfort giving and receiving feedback.
Flexibility and a highly cooperative approach.
Demonstrated analytical and math skills.

Nice To Haves

Experience in hospital administration, medical office management, financial services, and/or business operations.

Responsibilities

Proactively manage an assigned block of claims by regularly communicating with customers, understanding their level of functioning, and maintaining command of case facts.
Develop and document strategic case plans that focus on the future direction of each claim from a holistic viewpoint.
Determine customer eligibility by reviewing contractual language and medical documentation, interpreting information, and making fact-based decisions.
Use claim dashboards to manage inventory and prioritize claims for maximum impact.
Discuss return-to-work opportunities with customers and employers using an action-oriented approach.
Work with clients and Vocational Rehabilitation Counselors to facilitate full-time or modified-duty return to work.
Ask focused questions of internal and external resources to resolve discrepancies, close information gaps, and clarify inconsistencies.
Conduct detailed phone conversations with customers and physicians to manage claims, from initial medical requests through evaluation of ongoing medical information.
Complete potentially complex monthly benefit calculations and have them reviewed for accuracy.
Execute client performance guarantees and respond to communications clearly, concisely, and within customer service protocols.
Make fair, accurate, timely, and quality claim decisions.
Follow standard timeframes for processing mail, tasks, and outliers.
Support and promote integration initiatives, including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, and Healthcare Connect.
Clearly explain claim decisions verbally and in writing.
Understand and follow corporate compliance requirements, policies, procedures, and best practices.
Stay current with training associated with the role and business-unit objectives.