Claim Review 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. Click here to learn more about Group Benefits solutions.

Locations: Hybrid/Remote - United States

Role Summary

The Claim Review program is a key part of the group benefits operating model. We are seeking expertise to expand and optimize the Claim Review program. The Claim Review Manager role will lead a team comprised of Claim Reviewers supporting designated blocks of business, as part of the larger Claim Review program. The role will also be focused on providing insights via industry leading quality and risk management practices and drive continuous improvement initiatives. The ideal candidate will have excellent communication and influencing skills and a strong background in quality management, risk assessment, and business process optimization.

Key Responsibilities

• Drive the vision of Quality throughout the organization, establishing a culture that challenges the status quo and fosters business process improvement.
• Acts as a figure of authority / SME regarding review methodology and its application(s) to processes.
• Researches, interprets and responds to inquiries from internal customers regarding identified quality trends and root cause analysis.
• Analyze program claim review results to assess quality trends, root cause, or targeted focus areas to inform the broader quality review program and business partner insights.
• Drive change and influence individuals at all levels of the organization to minimize risks exposure.
• Manages relationship with any compliance, legal and external audit partners (e.g. SOX, SSAE - 16 and Corporate Audit)
• Evaluate Review efficiency in partnership with Business Stakeholders by utilization of quality methodology based on actionable data, such as implementation of KPIs, internal evaluation process, data analysis etc.
• Oversee global and effective communications of review results by ensuring delivery of actionable insights to internal business partners for action plans
• Proposes changes in designing, implementing and monitoring of complex review programs.
• Develops review policies and procedures.
• Design and develop Quality Systems Strategy for Group Operations to ensure consistency of delivery and measurable results in alignment with the expectations of our customers.
• Manages productivity and overall review performance of direct reports.
• Develops functional team members through effective coaching and guidance, empowering and enabling strong leadership from each.
• Leads People Initiatives (with HR) including compensation planning, performance management, staffing and employee relations concerns/issues, employee recruitment, training, teaming and employee development.
• Develops functional team members through effective coaching and guidance, empowering and enabling strong leadership from each.
• Responsible for driving business operations projects and initiatives as assigned.
• Oversee outcomes of audit calibration sessions.
• Oversee outcomes of Business Partner claim resolutions.
• Maintains audit databases and systems

• In collaboration with Claim Review leadership, contribute to the development and analysis of key metrics that promote program health and operational quality performance to the broader New York Life executive leadership team.
• Manages Quality Team in regard to internal quality and productivity goals as well as Compliance requirements (e.g. SOX, internal Audit, Privacy...)

• Other duties as assigned.

Role Requirements:

• Bachelor's degree in a relevant field (Business, Risk Management, Insurance, or a related discipline).
• Minimum of 7 years of experience in quality management, risk management, or related roles, preferably within the insurance or financial services industry.
• In-depth knowledge of quality management principles, risk assessment methodologies, and regulatory requirements related to group benefit solutions.
• Strong analytical and problem-solving skills with the ability to identify and reduce business risks effectively.
• Proven track record of developing and implementing quality and risk management frameworks, policies, and procedures to drive continuous improvement.
• Excellent communication and relational skills, with the ability to collaborate and influence stakeholders at all levels of the organization.
• Exemplified leadership skills and the ability to build and motivate high-performing teams.
• Ability to work in a fast-paced, dynamic environment, managing multiple priorities and deadlines effectively.
• Strong business acumen and critical thinking to align quality and risk management initiatives with overall business objectives.

Skills and Abilities

• Must be able to perform complex data analysis functions in Excel including reviewing and sanitizing text delimited files, V, H & X-lookups, and pivot tables.
• Excellent verbal & written communication skills with a keen ability to translate large data analysis and observations into comprehensive yet concise messaging to a non-data savvy audience.
• Has an affinity for innovation to find new and better ways to consume data to ease customer burden while enhancing the overall experience.
• Demonstrates a growth mindset by being adaptable, agile, and willing to change course in trying new ways of working.
• An ability to connect technical aspects of the work to the customer experience.
• Strong organization skills with an ability to adapt to competing priorities.

Pay Transparency

Salary range:$100,000-$170,000

Overtime eligible:Exempt

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 here to discover more about our comprehensive benefit options or visit our NYL 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 of Fortune's World's Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by theFoundation.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 www.NewYorkLife.com.

Job Requisition ID:92057

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