High Level Overview
Another name for a pending claim is...?
Initial investigation
This Federal Act is designed to protect an employees disability benefits and set standards for those who administer the plan
Employee Retirement Income Security Act of 1974 (ERISA)
What is the very first thing a claims manager should consider when looking at a brand new claim?
Determine if the employee is eligible for LTD benefits?
Active Status and Closed Status
Number of days we as Claim Managers with NYL have to make attempts to contact the Customer via phone?
10 days
Considering we have received all necessary documentation to make an approval, how long should a CM wait to make that decision?
CM should NOT wait to make any decision.
What is a pending claim?
A pending claim is a claim that has been received, but the Claim Manager hasn't made a decision yet on whether benefits are due.
Amount of days we as NYL Claim Managers have to send our first delay letter to our customer/claimants?
30 days
The date you receive the last piece of information needed to make a claim decision?
Proof of Loss (POL)
What are the FOUR steps following claim intake in the Pending Claim Workflow?
Review Policy, Triage, Gather Information, Review Information
_________ arrangements that large employers use to ensure certain levels of service performance and customer experience?
Performance Guarantee (PG)
To determine if a claim is payable, name one of the key questions we as claims managers evaluate in an initial investigation review? (select one)
What is eligibility? What are exclusions? What are Pre-Existing Conditions? What is the definition of disability?