Voluntary Benefits Claims Manager

New York Life Insurance Co•Remote, any

2d•Remote

About The Position

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. As a VB Claims Manager, you will be assigned a caseload of VB claims that will consist of all VB products including Hospital Indemnity (HI), Accident (AI) & Critical Illness (CI). Primary duties will include conducting thorough investigations to determine eligibility, liability and financial accuracy of all claims received. A key component of this role will also include a focus on providing a service excellence experience that is second to none.

Requirements

High School diploma or GED required.
Proficiency with MS office applications is required (Work, Outlook, Excel).
Must be technically savvy with the ability to toggle between multiple applications and/or computer monitors simultaneously.
Strong critical thinking, analytical and investigative skills with the ability to gather information, analyze facts & draw conclusions.
Strong verbal & written communication skills is needed to develop comprehensive claims records.
Ability to work with a bias for action and have a strong focus on service excellence.
Effective interpersonal, written and verbal communication skills including the ability to explain complex claim scenarios.
A key capability includes the ability to translate complex situations into easily understandable language for customers and claimants.

Nice To Haves

BA/BS degree or equivalent work experience strongly preferred.
2+ years of Group Benefits experience is strongly preferred.
Experience administering any GBS claims product (e.g., STD, LTD, FML/PFML, Life/AD&D) preferred.

Responsibilities

Accountable for managing a caseload of claims that will include all VB products as well as Wellness offerings where appropriate. New claim submissions may be received telephonically, via paper form or digitally. Proactive claims processing may also occur based on customer agreements.
Determine eligibility of benefits by reviewing contractual language alongside medical information leading to accurate and timely claims decisions. These decisions should have a focus on overall quality outcomes that deliver a best-in-class experience marked by our service excellence approach.
Perform multi-policy checks where appropriate to determine if New York Life claimants with active disability and/or Life claims may be eligible for additional VB benefits as a result of their condition(s) in support of GBS service integration initiatives.
Effectively communicate with claimants, employers, and various medical professionals both verbally and in writing to gather information necessary to aide in the claims process.
Respond to all telephonic and email inquiries within established customer service protocols while also adhering to standard timeframes. Should also ensure execution on all customer performance guarantees as defined.
Must document clear and concise claims notes based on all documentation received/reviewed as well as conversations with the customer, provider, or claimant to support rationale for determinations.
Work collaboratively across both the VB claims team as well as the broader GBS claims organization to ensure a cohesive business unit driving to deliver customer value.
Daily adherence to New York Life & corporate compliance policies, procedures & best practices.
Focus on ongoing development via training associated with the role & business objectives while remaining current on any compliance-driven training curriculum.
Given the newness of the VB product suite, Claims Managers may be asked to aide in validating accuracy and appropriateness of technology builds within the claims system. This is critical to ensure that the team is enabled to be successful while maximizing technology to increase efficiency.
Role may also require periodic Business Acceptance Testing (BAT) support as system enhancements are delivered.