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New York, New York, United States • Remote Solely
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Research and process claims for Group Life and Accidental Death and Dismemberment products by determining financial liability and eligibility. Communicate decisions and status updates to customers and clients while ensuring compliance with contractual and legal guidelines.
A bachelor's degree in a Health or Science field and a background in Forensic Science are highly desired. Candidates must possess strong investigative skills and the ability to analyze complex medical and legal records to make accurate claim decisions.
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.
Role Overview:
As an AD&D Claims Senior Representative in the Accidental Death and Dismemberment department, you will partner with medical, legal and other expert resources to research, determine financial liability, and process claims for Group Life, Accidental Death and Dismemberment, Group Business Travel Accident and other specialty products. This includes making determinations regarding eligibility for benefits, providing ongoing claim administration, and communicating decisions and status updates to customers and clients.You have a direct impact on customers’ well-being and sense of security. The ability to make and effectively communicate decisions within compliance guidelines, while integrating knowledge of customer contracts, Group Operations and corporate compliance are critical for success.
What You'll Do:
• Independently conduct claim eligibility determinations and manage on-going claims for benefits through applying appropriate contractual provisions and following legal guidelines.
• Proactively communicate with customers, beneficiaries, business partners, and employers, to gather information regarding eligibility for benefits.
• Manage complex claims with minimal supervision, and recognize when assistance from Technical Specialist and/or Team Leader is needed.
• Interpret and evaluate death investigation records (police, autopsy, toxicology, forensic investigative reports, foreign documents, medical records, etc.) against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud.
• Independently refer claims to medical, legal and other Expert Resources when appropriate.
• Demonstrate solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues.
• Consistently drive initiatives/efforts to successful and compliant outcomes.
• Provide coaching to other employees as needed.
• Complete all departmental required trainings within assigned timeframes.
• Independently respond to high levels of call volume or other communications from customers and clients. Respond to all telephonic and email inquiries within customer service protocols in a clear, concise, empathetic and timely manner.
• Embodies company’s commitment to high ethical and fair claim standards, corporate compliance, Policies and Procedures and best practices with employees.
What You'll Bring:
• BA/BS degree or equivalent work experience with focus in Health or Science field desired.
• Forensic Science education and/or background highly desired.
• Strong investigative skills; ability to gather information, analyze facts, and draw conclusions; demonstrated ability to problem solve, utilize analysis, experience and judgment to make accurate decisions.
• Clear and concise and timely professional communications using all mediums.
• Experience in delivering exceptional customer service.
• Team oriented focus with ability 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.
• Integrity, objectivity and personal accountability for own decisions and honors both internal and external commitments.
• Accepts challenges and demonstrates accountability for own developmental opportunities.
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
• Proficient in Microsoft Office applications (Word, Outlook).
Competencies:
1. Decision Quality
2. Customer Focus
3. Communicates Effectively
4. Action Oriented
5. Optimizes Work Processes
6. Manages Complexity
It is recommended that all qualified candidates apply to this posting as soon as possible. Residents of Colorado are hereby notified that the deadline to apply is two weeks from the Posting Date listed above.
#LI-AP3
#LI-REMOTE
Pay Transparency
Salary range: $45,000-$60,000
Overtime eligible: Nonexempt
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 the Foundation. 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: 94405
#GBS
For over 180 years, we’ve helped turn your biggest dreams into milestones that last a lifetime. As a mutual company we hold ourselves to the highest standards of transparency, objectivity, and integrity. We’re committed to improving local communities through a culture of giving and volunteerism, supported by our own New York Life Foundation. Join a company that values development, career growth, collaboration, innovation, and diversity & inclusion. Through various resources and programs, you can grow your career while developing personally and professionally. Your life. New York Life. More powerful, togetherᵀᴹ. Insurance • Investments • Retirement • Advisory Services New York Life is an Equal Opportunity Employer - M/F/Veteran/Disability/Sexual Orientation/Gender Identity Investments are offered through NYLIFE Securities LLC (Member FINRA/SIPC), a Licensed Insurance Agency. Advisory services are offered through Eagle Strategies LLC, a Registered Investment Adviser. NYLIFE Securities LLC and Eagle Strategies LLC are New York Life Companies. Not all New York Life agents are licensed to offer investments or advisory services. Only those agents who disclose their affiliation with NYLIFE Securities LLC and/or Eagle Strategies LLC are credentialed to provide the respective products and services. Read our disclaimers: https://nyl.co/socialmedia
Offices: 51 Madison Avenue, New York, New York 10010, US
There are currently 11,422 open customer service & support positions in New York, NY listed on Clera. New openings are added daily as companies post roles.
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