短期伤残理赔经理
Short Term Disability Claims Manager
职位描述：远程办公
Group Benefit Solutions 为中型和大型公司提供全面的保险和缺勤管理解决方案。我们的工作有助于打造更健康、更快乐、更安全的员工队伍，为纽约人寿保险公司的传统——在我们需要的时候出现——做出贡献。在这里，你将直接设计、实施和支持这些直接影响员工生活的解决方案。我们核心业务是通过缺勤、意外、残疾、自愿福利和人寿保险解决方案，为人们提供财务保障和安心。点击此处了解有关团体福利解决方案的更多信息。
职位概述：作为短期残疾（STD）理赔经理，你将获得开展深入调查所需的知识和技能，确定客户是否符合短期残疾资格，进行持续的理赔管理，并传达决定和状态更新。这是一份节奏快的工作，注重细节至关重要。理赔经理的决定直接影响客户的健康、福祉和安全感。在紧迫的时间框架内做出并有效传达决策，同时整合对医疗状况、客户合同、团体福利解决方案和公司合规性的理解，是成功的关键。
你将负责：
- 对分配的短期残疾理赔案件进行理赔/客户资格认定，并管理持续的理赔，包括收集医疗信息、应用适当的合同条款、遵循法律指南，并利用专家资源。
- 与理赔人、雇主和各种医疗专业人员沟通，以获取关于短期残疾福利申请、支付及持续管理的信息。
- 支持并推动所有整合计划（包括家庭病假、生命援助计划、综合个人健康团队、Your Health First、Healthcare Connect 等）。
- 能够处理来自客户和客户的高通话量。
- 回应各种书面和电话咨询，包括资格、批准/拒绝决定、状态以及福利的继续或终止。
- 直接与客户和职业康复顾问合作，协助其以全职或调整职责的方式重返工作岗位。
- 与客户和医生建立联系，对理赔进行医学管理，从最初的医疗评估开始。
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Location Designation: Fully Remote
Group Benefit Solutions deliverscomprehensive 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 beingthere 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 Overview:As a Short Term Disability (STD) Claims Manager, you will develop the knowledge and skills needed to conduct thorough investigations, make determinations regarding short-term disability eligibility for our customers, provide ongoing claim administration, and communicate decisions and status updates. This is a fast-paced job where attention to detail counts. The Claim Manager’s decisions have a direct impact on customers’ health, well-being and sense of security. The ability to make and effectively communicate decisions within tight timeframes, while integrating knowledge of medical conditions, customer contracts, Group Benefit Solutions and corporate compliance are critical for success.
What You'll Do:
- Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources.
- Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.).
- Ability to handle potentially high levels of call volume from customers and clients.
- Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis.
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
- Pay all covered claims accurately and timely.
- Execute on all customer performance guarantees.
- Adhere to standard timeframes for processing mail, tasks and outliers.
- Understand Group Benefit Solutions and Corporate Compliance, Polices and Procedures and best practices.
- Stay abreast of ongoing trainings associated with role and business unit objectives.
- Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner.
What You'll Bring:
- 2 year minimum of professional experience.
- Strong critical, analytical and investigative skills; ability to gather information, analyze facts, and draw conclusions.
- Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
- Ability to build and maintain effective relationships.
- Effective interpersonal, written and verbal communication skills.
- Excellent planning, time management and organizational skills.
- Ability to manage multiple and changing priorities.
- Strong negotiation skills.
- Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
- Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
- Proficiency with MS Office applications is required (Word, Outlook).
- Proven track record of successfully driving results in a complex matrix environment is a (+).
- Additional experience administering FMLA and/or State Leaves is a (+).
- Knowledge of legal liability, insurance coverage and medical terminology is a (+).
- HS Diploma or GED required. Bachelor’s degree strongly preferred.
Technology Requirements:Functioning broadband (cable/DSL) should meet the following minimum requirements 50mb download/20mb upload speed. Ability to hardwire into internet connection required.
Pay Transparency
Salary range: $42,500 - $57,500
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 hereto discover more about our comprehensive benefit options or visit ourNYL 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 ofFortune’sWorld’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 .
Job Requisition ID: 94327
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Originally posted on Himalayas