Group Claim Representative


Date: May 15, 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.




Group Claim Representative – Life (Basic Retiree)


As a Group Claim Associate, you will develop the knowledge and skills needed to conduct a basic claim investigations, make determinations regarding eligibility for benefits, provide ongoing claim administration, and communicate decisions and status updates.  This role will manage high volume, and attention to detail is important. The Group Claim Associate’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, Cigna Group Operations and corporate compliance are critical for success.


As Group Claim Representative for the Life department, you will:


  • Make claim / customer eligibility determinations and manage on-going claims for retirees and basic life benefits through, applying appropriate contractual provisions, following legal guidelines, and working closely with Technical leadership.
  • Communicate with customers, beneficiaries, business partners, and employers, to gather information regarding assessing eligibility and ongoing management of benefits.
  • With supervision, respond to high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
  • Pay all covered claims accurately and timely
  • Execute on all customer performance guarantees          
  • Adhere to standard timeframes for processing mail, tasks and outliers
  • Understand Cigna Group Operations and Corporate Compliance, Policies and Procedures and best practices  
  • Stay abreast of ongoing trainings associated with role and business unit objectives
  • Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner


  • 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)
  • 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 (+)


  1. Decision Quality
  2. Customer Focus
  3. Communicates Effectively
  4. Action Oriented
  5. Interpersonal Savvy


Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.



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

Job Requisition ID: 83191




Nearest Major Market: Pittsburgh

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