Accidental Death and Dismemberment Senior Claim Representative

New York Life Insurance Co.; Pittsburgh (Allegheny County); Remote; USD 48,000 - 55,000; Full time

Job summary

New York Life Insurance Co. is seeking a GBS AD&D Claim Senior Representative to process and adjudicate claims in a remote setting. You will work with medical, legal and other experts to determine liability, review records, and communicate decisions to customers with empathy and accuracy.

The role requires a Health/Science background or related education, strong problem-solving and client-service skills, and the ability to navigate complex contracts and compliance guidelines.

Qualifications

• BA/BS degree or equivalent work experience with a focus in Health or Science field required.
• Master’s degree in Forensic Science and/or background or 4–7 years of relevant experience in Life or Disability preferred.
• Demonstrated ability to problem-solve, utilize analysis, experience, and judgment to make accurate decisions.
• Clear, concise, and timely professional communication using all mediums.
• Experience in delivering exceptional customer service.
• Team-oriented focus with the ability to perform at the highest level.

Responsibilities

• Proactively communicate with customers, beneficiaries, business partners, and employers to gather information regarding eligibility for benefits.
• Manage complex claims with minimal supervision within established time frames and recognize when assistance from Technical Specialist and/or Team Leader is needed.
• Interpret and evaluate death investigation records against applicable contract provisions, including exclusions and fraud.
• 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.
• Respond to all telephonic and email inquiries within customer service protocols in a clear, concise, empathetic, and timely manner.

Skills

Problem-solving

Communication

Customer service

Team-oriented

Prioritization

Integrity

Microsoft Office

Education

BA/BS degree

Master’s degree or 4–7 years experience

Tools

Word

Outlook

Excel

PowerPoint

Teams

SharePoint

Job description

Location Designation: Fully RemoteGroup 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.

Role Overview:

As a GBS AD&D Claim 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. The GBS AD&D Claim Senior Representative’s decisions 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:

• Proactively communicate with customers, beneficiaries, business partners, and employers to gather information regarding eligibility for benefits
• Manage complex claims with minimal supervision within established time frames and recognize when assistance from Technical Specialist and/or Team Leader is needed
• Interpret and evaluate death investigation records (e.g., police, autopsy, toxicology, forensic investigative reports, foreign documents, and medical records) against applicable contract provisions, including exclusions, limitations, material misrepresentations, and fraud
• 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 support initiatives/efforts to successful and compliant outcomes
• Complete all GBS and NYL required trainings within assigned timeframes
• Respond to all telephonic and email inquiries within customer service protocols in a clear, concise, empathetic, and timely manner
• Embod e the company’s commitment to high ethical and fair claim standards, corporate compliance, policies and procedures, and best practices

What You’ll Bring:

• BA/BS degree or equivalent work experience with a focus in Health or Science field required
• Master’s degree in Forensic Science and/or background or 4–7 years of relevant experience in Life or Disability preferred
• Demonstrated ability to problem-solve, utilize analysis, experience, and judgment to make accurate decisions
• Clear, concise, and timely professional communication using all mediums
• Experience in delivering exceptional customer service
• Team-oriented focus with the 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 decisions; honors both internal and external commitments
• Accepts challenges and demonstrates accountability for developmental opportunities
• Proficient in Microsoft Office applications (Word, Outlook, Excel, PowerPoint, Teams, SharePoint

Pay Transparency

• Salary range: $48,000-$55,000
• 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.

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.

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.

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