LTD (Long Term Disability) Claim Manager - Pittsburgh

• 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 timeframes 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 having thorough phone conversations
• Excellent organizational and time management skills
• Strong critical thinker
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
• Ability to focus and achieve production goals through high quality work
• Proficiency with MS Office applications is required (Word Outlook Excel)
• Strong written and verbal skills demonstrated in previous work experience
• Proven skills in positive and effective interaction with challenging customers
• Experience in effectively meeting/exceeding individual professional expectations and team goals
• Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset
• Comfortable giving and receiving feedback
• Flexible to change and highly cooperative
• Demonstrated analytical and math skills

• Critical Thinking
• Trust and Transparency
• Bias for Action
• Leads with Agility
• Customer Orientation

• Fitness center
• Tenant lounge
• Nearby retail
• Bike storage
• Outdoor space
• Concierge services
• Dry cleaning
• EV charging stations
• Puttery mini golf
• The Roaming Bean Coffee
• Tapville Social
• Onsite free parking

What We Do

At New York Life our 180-year legacy of integrity mutuality and financial strength fuels a future defined by bold transformation. As the largest mutual life insurance company in the U.S. we operate on behalf of our policy owners—not shareholders. That structure allows us to take a long-term view investing in people purpose and innovation that endures. Guided by a clear enterprise vision to become a technology- data- and AI-powered company we’re modernizing our platforms rearchitecting experiences and embedding intelligence across our products and services. Our mission has always been about helping people through life’s most meaningful moments. Today technology is amplifying that mission—enabling us to serve clients advisors and communities in more personalized proactive ways. With a diversified business portfolio spanning insurance investments retirement group benefits and direct-to-consumer offerings New York Life delivers the stability of a Fortune 100 company with the agility of one that’s continuously evolving. We’re powered by a values-led culture inclusive teams and a shared belief that when our people thrive so does our company. Here tradition fuels momentum—and your ideas energy and growth power what’s next.

Why Work With Us

New York Life is transforming from the inside out—blending 180 years of trust with the velocity of innovation. What makes us different is our culture: grounded in integrity humanity and shared success—values that show up in how we work lead and grow. If you want a place where innovation has purpose—build what's next with us.

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