Accidental Death and Dismemberment Claims Specialist

 

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. Click here to learn more about Group Benefits solutions.

 

 

Role Overview:

 

As a Group Claim Associate 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 various products:

• Group Life,
• Group Accidental Death and Dismemberment, and
• Group Business Travel Accident
• 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 Group Claim Associates 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: 

 

• 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 as 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
• Demonstrates solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues.
• Consistently drives 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 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. 

 

 

What you'll bring:

 

• BA/BS degree or equivalent work experience with focus in Health or Science field desired
• Forensic Science education and/or background highly desired 
• 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