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

Role Description

• Independently conduct claim eligibility determinations and manage on-going claims for benefits through applying appropriate contractual provisions and following legal guidelines.
• Proactively communicate with customers, beneficiaries, business partners, and employers, to gather information regarding eligibility for benefits.
• Manage complex claims with minimal supervision, and recognize when assistance from Technical Specialist and/or Team Leader is needed.
• Interpret and evaluate death investigation records (police, autopsy, toxicology, forensic investigative reports, foreign documents, medical records, etc.) against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud.
• Independently 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 drive initiatives/efforts to successful and compliant outcomes.
• Provide coaching to other employees as needed.
• Complete all GBS and NYL required trainings within assigned timeframes.
• Independently respond to high levels of call volume or other communications from customers and clients. Respond to all telephonic and email inquiries within customer service protocols in a clear, concise, empathetic and timely manner.
• Embodies company’s commitment to high ethical and fair claim standards, corporate compliance, Policies and Procedures and best practices with employees.

Qualifications

• BA/BS degree or equivalent work experience with focus in Health or Science field desired.
• Forensic Science education and/or background highly desired.
• Strong investigative skills; ability to gather information, analyze facts, and draw conclusions; demonstrated ability to problem solve, utilize analysis, experience and judgment to make accurate decisions.
• Clear and concise and timely professional communications using all mediums.
• Experience in delivering exceptional customer service.
• Team oriented focus with 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 own decisions and honors both internal and external commitments.
• Accepts challenges and demonstrates accountability for own developmental opportunities.
• Must be technically savvy with the ability to toggle between multiple applications and/or computer monitors simultaneously.
• Proficient in Microsoft Office applications (Word, Outlook).

Requirements

• Decision Quality
• Customer Focus
• Communicates Effectively
• Action Oriented
• Optimizes Work Processes
• Manages Complexity

Benefits

• Full package of benefits for employees including leave programs, adoption assistance, and student loan repayment programs.
• Annual discretionary bonus eligibility.
• Participation in an incentive program.

Company Description

At New York Life, our 180-year legacy of purpose and integrity fuels our future. As we evolve into a more technology-, data-, and AI-enabled organization, we remain grounded in the values that drive lasting impact.

Our diverse business portfolio creates opportunities to make a difference across industries and communities—inviting bold thinking, collaborative problem-solving, and purpose-driven innovation. Here, you’ll find the rare balance of long-standing stability and forward momentum, supported by an inclusive team that honors tradition while embracing progress.

As a Fortune 100 mutual company, we offer a place to grow your skills, contribute to meaningful work, and deliver solutions that matter. Your ideas drive what’s next, and your growth powers it.