When you join New York Life, you’re joining a company that values development, career growth, collaboration, innovation, and diversity & inclusion. We want employees to feel proud about being part of a company that is committed to doing the right thing. Through various resources and programs, you can grow your career while developing personally and professionally.
The Quality Review Specialist (QRS) Role partners with Senior Claim Managers and Team Leaders to ensure execution on fair claims handling practices. They will review LTD claim decisions; complete quality reviews and provides real-time insights to Senior Claim Managers and Team Leaders. Ensures Senior Claim Managers follow up and review best practices and key policies and procedures.
As a Quality Review Specialist (QRS), you will:
- Partners with Senior Claim Managers to review claim files according to fair claims and compliance standards by completing quality reviews, identifying trends and developing coaching and training opportunities
- Partners with Senior Claim Managers on consultation of claim scenarios in real time to find most appropriate actions based on fair claims standards and P&P guidelines
- Partners with various roles to ensure business objectives are achieved in a highly compliant and ethical manner consistent with governing laws and regulations including, but not limited to, fair claims standards, Sarbanes-Oxley and SAS 70 Controls
- Informs Cigna Group Operations and Corporate Compliance, Policies and Procedures and best practices to Senior Claim Managers and/or employees. As new regulations and updates are communicated, ensures Senior Claim Managers are sufficiently trained and comprehend the regulations and updates.
- Stays abreast of ongoing trainings associated with role and business unit objectives, as well as ensuring Senior Claim Managers are updated on role-appropriate trainings
- Demonstrates solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues
- Looks for new ways to accomplish objectives and takes extra steps to deliver customer service that meets and exceeds expectations.
- Ensures a consistent high performance work culture exists
- Demonstrates strong analytical and critical thinking skills to solve complex claim issues
- Suggests improvements, sets high standards and works diligently to achieve financial business objectives
- Demonstrates ability to comprehend, interpret and effectively convey contractual language
- Works with business partners to ensure successful implementation of new best practices and processes
- Provides ongoing enhancements of all systems to ensure successful implementation
- Accountable for own decisions and honors both internal and external commitments
- Accepts challenges and demonstrates accountability for own developmental opportunities
- BA/BS degree or equivalent work experience
- Previous experience managing, directing or coaching others
- Minimum of 4 years long term disability claim management experience
- Minimum of 1 year of Senior Claim Manager experience
- Business acumen of group insurance industry
- Experience in delivering exceptional customer service
- Strong drive for results
- Team oriented focus with ability to motivate team to perform at the highest level
- Ability to prioritize critical objectives focusing on high impact components
- Maintains professionalism and flexibility despite conflicting demands
- Executes decisiveness even when dealing with ambiguity
- Ability to learn process and product information and adapt quickly and effectively
- Strong analytical skills and ability to comprehend and clarify complex concepts
- Excellent communication, organizational, negotiation, conflict resolution and presentation skills
- Clear and concise professional communication using all mediums
- Integrity, objectivity and personal accountability
- Proficient in Microsoft Office
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 our Foundation. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.
Job Requisition ID: 83454