Life Claims Senior Specialist

New York Life Insurance Co.; Watertown (CT); Remote; USD 50,000 - 55,000; Full time

Benefits offered by this job

Adoption assistance

Student loan repayment programs

Leave programs

Job summary

New York Life Insurance Co. is seeking a Life Claims Specialist to join Group Benefit Solutions. You will develop skills to conduct life insurance claim investigations, determine eligibility, administer ongoing claims, and clearly communicate decisions to customers.

The role demands high accuracy and strict adherence to compliance in a high-volume environment. You will coordinate with customers, beneficiaries, employers and partners to gather information, assess eligibility, and manage benefits

Qualifications

• One year minimum of professional experience preferred.
• HS Diploma or GED required; Bachelor's degree strongly preferred.
• Proficiency with MS Office applications (Word, Outlook, PowerPoint, Teams, Excel, SharePoint).
• Proven track record of driving results in a complex matrix environment.
• Ability to gather information, analyze facts, and draw conclusions.
• Works with urgency and a customer focus mindset.
• Strong interpersonal, written and verbal communication skills.
• Excellent planning, time management and organizational skills.
• Ability to manage multiple changing priorities.
• Knowledge of legal liability, insurance coverage and medical terminology is a plus.

Responsibilities

• Complete life claim eligibility determinations and manage ongoing claims.
• Respond to high call volumes and inquiries regarding life benefits.
• Communicate with customers, beneficiaries, partners, and employers to gather information.
• Respond to inquiries on eligibility, approvals/denials, status and continuation of benefits.
• Pay all covered claims up to $60,000 accurately and efficiently.
• Refer claims to Expert Resources with guidance from leadership.
• Learn to identify medical records needed for claim reviews.
• Adhere to customer service protocols and deadlines.

Skills

Analytical thinking

Communication skills

Customer focus

Time management

Relationship building

Negotiation skills

Education

HS Diploma or GED

Bachelor’s degree

Tools

MS Office Suite

Job description

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.

Role Overview

As a Life Claims Specialist, you will develop the skills needed to conduct Life Insurance claim investigations, make determinations regarding eligibility for benefits, provide ongoing claim administration, and communicate decisions and status updates. This role will manage a high volume, and attention to detail is important. Your 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, GBS Group Operations and corporate compliance are critical for success.

What You'll Do

• Complete Life claim customer eligibility determinations and manage on-going claims through, applying appropriate contractual provisions, following legal guidelines, and working closely with technical leadership.
• Respond to high levels of call volumes from customers and clients. With supervisory support, respond to written and telephone inquiries proactively and empathically regarding life benefits
• Communicate with customers, beneficiaries, business partners, and employers, to gather information regarding assessing eligibility and ongoing management of benefits.
• With close supervision, respond to written and telephone inquiries from customers, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
• Pay all covered claims up to $60,000.00 accurately and efficiently with minimal supervision
• Refer claims to Expert Resources with guidance from technical leadership
• Learn to identify medical records needed to assist with claim reviews
• Execute on all customer performance guarantees
• Adhere to standard timeframes for processing mail, tasks and outliers
• Understand Group Benefit Solutions (GBS) and Corporate Compliance, Policies and Procedures and best practices
• Complete all GBS and NYL required trainings within designated deadlines
• Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner

What You'll Bring

• One year minimum of professional experience strongly preferred
• HS Diploma or GED required. Bachelor's degree strongly preferred.
• Proficiency with MS Office applications is required (Word, Outlook, PowerPoint, Teams, Excel, SharePoint)
• Proven track record of successfully driving results in a complex matrix environment is a (+)
• Ability to gather information, analyze facts, and draw conclusions
• Works with a sense of urgency and is a self-starter with a customer focus mindset
• Ability to build and maintain effective relationships
• Effective interpersonal, written and verbal communication skills
• Excellent planning, time management and organizational skills
• Ability to manage multiple and changing priorities.
• Strong negotiation skills
• Knowledge of legal liability, insurance coverage and medical terminology is a (+)

Pay Transparency

• Salary range: $50,000-$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 Fortunes 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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