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.

The 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.

• 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 time frames 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

• High School Diploma or GED required, with 3 years minimum of professional experience or bachelor’s degree strongly preferred
• Experience in hospital administration, medical office management, financial services and/ or business operations is a (+)
• Comfortable talking with customers and…