Senior AD&D Claims Specialist - Remote

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

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.