[Hiring] Accidental Death and Dismemberment Senior Claim Representative @New York Life

Role Description

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
• Embody the company’s commitment to high ethical and fair claim standards, corporate compliance, policies and procedures, and best practices

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
• 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)

Requirements

• Salary range: $48,000-$55,000
• Overtime eligible: Nonexempt
• Discretionary bonus eligible: Yes
• Sales bonus eligible: No

Benefits

• Full package of benefits for employees
• Unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs
• Continuous refinement and addition of benefits based on employee feedback