[Hiring] Life Claims Senior Specialist @New York Life

Role Description

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 ongoing 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.

Qualifications

• 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 (+).

Requirements

• Salary range: $50,000-$55,000.
• Overtime eligible: Nonexempt.
• Discretionary bonus eligible: Yes.
• Sales bonus eligible: No.

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.

Company Description

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.