Disability Claims Examiner - Stable & Mature Claims

About the role

As part of New York Life’s Group Membership Association Division, you'll be working with the nation’s No. 1 provider of life and disability income insurance solutions for association/affinity programs. Beyond the tailored life and disability income insurance solutions you provide, your work fosters a sense of community and shared support within affinity groups.

New York Life is seeking a Disability Claims Examiner to support our Stable & Mature (SAM) Long Term Disability claim portfolio. This role is responsible for administering established disability claims that require ongoing certification, benefit maintenance, documentation review, and customer support. The successful candidate will manage a caseload of long-duration disability claims, review medical and claim documentation, ensure continued eligibility for benefits, and maintain accurate claim records in accordance with company policies and procedures. The position requires strong organizational skills, attention to detail, sound judgment, and a commitment to delivering exceptional customer service. The Stable & Mature Examiner serves a critical role in ensuring ongoing disability claims remain properly supported, accurately administered, and responsive to customer needs while maintaining operational excellence and compliance standards. This position provides an opportunity to develop deep expertise in disability claims management while making a meaningful impact on customers who rely on their benefits. This position is expected to provide operational support to the DI Claims department by administering HIP (Hospital Indemnity) and Rabies claims as needed. The role also provides primary phone support to the DI department. The SAM Examiner is also expected to provide backup coverage to the department admin in the creation of new claims and the scanning of documents.

Responsibilities

• Manage an assigned inventory of Stable & Mature Long Term Disability claims.
• Conduct annual disability certification reviews and related follow-up activities.
• Review Medical Physician Statements (MPS), medical updates, and supporting claim documentation.
• Determine whether established disability claims continue to meet eligibility requirements.
• Maintain accurate and complete claim documentation and file records.
• Ensure claim activities are documented timely and in accordance with departmental standards.
• Monitor certification due dates, benefit milestones, and follow-up requirements.
• Maintain reminders, diary dates, and claim action items.
• Verify claim coding, benefit information, and supporting documentation.
• Process benefit continuation and claim closure activities when appropriate.
• Ensure claims remain compliant with policy provisions and claim management requirements.
• Identify gaps, inconsistencies, or material changes in claim information and determine the additional documentation or follow-up required.
• Review functional information and identify material changes in a claimant's condition.
• Obtain additional documentation when required.
• Coordinate referrals for medical review in accordance with established procedures.
• Serve as the primary point of contact for assigned claimants.
• Communicate complex or sensitive claim information clearly and professionally to claimants, physicians, employers, and internal business partners.
• Respond to inquiries regarding claim status, documentation needs, and benefit administration.
• Deliver a positive customer experience through timely, accurate, and empathetic service.
• Provide backup phone coverage for examiners within the DI Claims Department.
• Maintain compliance with company policies, procedures, and regulatory requirements.
• Support quality review and audit activities.
• Contribute to process improvement initiatives that enhance efficiency, accuracy, and customer experience.
• Demonstrate accountability for claim quality, timeliness, and service outcomes.

Requirements

• Prior experience in insurance, claims administration, disability benefits