Associate - Group Claims - Accidental Death & Dismemberment

APPLY NOW »

Date: Oct 13, 2021

Location: Pittsburgh, PA, US

Company: New York Life Insurance Co

 

When you join New York Life, you’re joining a company that values development, career growth, collaboration, innovation, and diversity & inclusion. We want employees to feel proud about being part of a company that is committed to doing the right thing. Through various resources and programs, you can grow your career while developing personally and professionally.

GBS2021

 

 

Role Summary: The Accidental Death & Dismemberment (AD&D) Group Claim Associate is responsible for evaluating and processing their assigned caseload of AD&D and business travel accident claims with a focus on making quality decisions in a timely manner. The claim associate is responsible for determining correct plan of action during claim evaluation and effective communication with customers, clients, internal business partners and applicable investigative agencies/treating medical facilities.

 

Responsibilities:

 

  • Evaluates eligibility, benefit amounts and appropriate beneficiary status based on contract policies
  • Interprets and evaluates accident policy, police, autopsy, toxicology, and forensic investigative reports and foreign documents as well as medical records and reports
  • Reviews and interprets claim documents against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud
  • Effectively interacts with Technical Specialist, Team Leader, medical and legal staff to determine accurate claim decisions within the confines of the policy and prevailing jurisdictional opinions
  • Communicates clearly with policyholders and beneficiaries or claimants with understandable explanations to inquiries 
  • Provides exceptional and ethical performance according to published quality and compliance standards including Performance Guarantees and consistent with governing laws and regulations
  • Demonstrates excellent knowledge of New York Life Group Benefit Solutions and Corporate Compliance, Policies and Procedures and best practices and continues to keep current with requirements and training.
    • Proactively identifies customer needs and creates innovative solutions to exceed customer service expectations
    • Respond to all communications within customer service protocols in a clear, concise and timely manner 
    • Make fair, accurate, timely, and quality claim decisions
    • Adhere to standard timeframes for processing mail, tasks and outliers

 

Preferred Qualifications:

 

  • BA/BS degree required 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 accountability for own decisions and honors both internal and external commitments 
  • Accepts challenges and demonstrates accountability for own developmental opportunities

 

Competencies:

Decision Quality

Communicates Effectively

Manages Complexity

Customer Focus

Action Oriented

 

#LI-LS1

 

 

Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by our Foundation. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.

Job Requisition ID: 84862

 

 

 


Job Segment: Claims, Social Media, Insurance, Marketing