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New York Life Insurance Co logo
Company Name:
New York Life Insurance Co
Approximate Salary:
Not Specified
Location:
Tampa, Florida
Country:
United States

CVP, Claims Practices & QA #43328

New York Life Insurance Company (“New York Life” or “the company”) is the largest mutual life insurance company in the United States*. Founded in 1845, New York Life is headquartered in New York City, maintains offices in all fifty states, and owns Seguros Monterrey New York Life in Mexico.

 

New York Life is one of the most financially strong and highly capitalized insurers in the business. The company reported 2016 operating earnings of $1.954 billion. Total assets under management at year end 2016, with affiliates, totaled $538 billion.  As of year-end 2016, New York Life’s surplus was $23.336 billion**.  New York Life holds the highest possible financial strength ratings currently awarded to any life insurer from all four of the major ratings agencies: A.M. Best, A++; Fitch AAA; Moody’s Aaa; Standard & Poor’s AA+. (Source: Individual Third Party Ratings Report as of 8/17/16).

 

Financial strength, integrity and humanity—the values upon which New York Life was founded—have guided the company’s decisions and actions for over 170 years.

Leads the NYL Direct Claims units ensuring the effective and efficient management of the claim functions so that valid claims are paid timely, the interests of the Company are protected, and all regulatory and compliance standards are adhered to. Ensure the established service standards are met and that a high quality of service to NYL insureds and their beneficiaries is maintained. 

Oversight of daily activities of Claims managers and staff to ensure we meet or exceed all department standards and state/regulatory requirements.  Ensure that NYL claims are adjudicated accurately, timely, and in compliance with NYL guidelines and state regulations.  Recommends and develops procedural and administrative policies and processes designed to improve productivity, protection of the Company, and to reduce expenses where possible.  Responsible for coordinating and responding to all Claims audits, both internal and State DOI initiated.  Responsible for responding to and handling all complex and sensitive service requests and escalations, including but not limited to, Chairman complaints, Threats of Suit, DOI complaints, etc.  Serves as department liaison for all Anti-Fraud efforts and activities and helps to develop any internal fraud detection and prevention procedures.   Directs investigations, analyzes and approves or denies rescission recommendation for life claims handled by the unit.  Supports and drives QC/QA functions within Claims to ensure high-risk processes are reviewed and monitored on an ongoing basis, and corrective action is performed to close process gaps. 

 

Requirements: 

Bachelor's degree and at least 10 years experience in Claims administration or related operations experience. 

Life insurance industry knowledge, NYL contract knowledge, advanced analytical problem-solving skills 

Must have technical knowledge of NYL contracts, Claims processing systems (CAPS, LSP, RVI, etc) as well as intermediate understanding of Microsoft Office (Word, Excel, PowerPoint, etc) 

Must have deep business knowledge of NYL contract language, claims process knowledge and state-specific regulations, deep understanding of incontestable and contestable processes and procedures within the department 

Direct leadership responsibility for managers and/or support staff with day-to-day operational workloads. Must ensure front-line managers are executing on daily responsibilities as well as support functions.  Must have ability to execute with conflicting and changing priorities in a dynamic high-paced environment. Must keep unit focused on NYL strategies and Dept. goals 

Escalated problem and complain cases must be reviewed, all aspects and facts must be gathered, and decisions must be rendered to protect NYL and resolve the customer issue.  Must have the ability to weigh all the facts of a particular case against prior experience, OGC advisement, and applicable rules/regulations to formulate well thought out decisions 

Strong decision-making ability is critical to the success of this position.  Final high-profile case adjudication must be well documented, supported by facts and legal interpretation, and must balance protecting the Company with resolving customer issues.  Claims must be paid or rescinded in accordance with all internal and state guidelines.  All process chgs must be vetted 

Very strong communication skills needed at all levels including, but not limited to: senior company executives, company and outside counsel, senior and mid-level NYL Direct management, state DOI representatives and regulators, front-line management and front-line staff.  Must have ability to communicate vision and direction of claims and NYL Direct. 

 

SF:LI-KH1

SF:EF-KH1

EOE M/F/D/V

 

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*Based on revenue as reported by “Fortune 500, ranked within Industries, Insurance: Life, Health (Mutual),” Fortune Magazine, June 17, 2016.  See http://fortune.com/fortune500/  for methodology.

**Total surplus, which includes the Asset Valuation Reserve, is one of the key indicators of the company’s long-term financial strength and stability and is presented on a consolidated basis of the company.

1. Operating earnings is the key measure use by management to track Company’s profitability from ongoing operations and underlying profitability of the business. This indicator is based on generally accepted accounting principles in the US (GAAP), with certain adjustments Company believes to be appropriate as a measurement approach (non GAAP), primarily the removal of gains or losses on investments and related adjustments.

2. Assets under management represent Consolidated Domestic and International insurance Company Statutory assets (cash and invested assets and separate account assets) and third party assets principally managed by New York Life Investment management Holdings LLC, a wholly owned subsidiary of New York Life Insurance Company.