Life Claims Senior Specialist

New York Life•Watertown, CT

1d•$50,000 - $55,000•Remote

About The Position

The Life Claims Senior Specialist works in Group Benefit Solutions, which provides insurance and absence management solutions to mid-sized and large companies. The role develops and applies the skills needed to investigate life insurance claims, determine eligibility for benefits, administer ongoing claims, and communicate decisions and status updates. It manages a high volume of work and requires careful, accurate decisions that affect customers’ well-being and sense of security. The specialist applies customer contract provisions and compliance guidelines while working with technical leadership. The role includes responding to customer and client inquiries, gathering information from beneficiaries and business partners, paying covered claims up to $60,000, and meeting service and processing timeframes. The position is fully remote.

Requirements

High school diploma or GED.
Proficiency with Microsoft Office applications, including Word, Outlook, PowerPoint, Teams, Excel, and SharePoint.
Ability to gather information, analyze facts, and draw conclusions.
Customer-focused self-starter who works with a sense of urgency.
Ability to build and maintain effective relationships.
Effective interpersonal, written, and verbal communication skills.
Strong planning, time management, and organizational skills.
Ability to manage multiple and changing priorities.
Strong negotiation skills.

Nice To Haves

At least one year of professional experience.
Bachelor’s degree.
A proven track record of successfully driving results in a complex matrix environment.
Knowledge of legal liability, insurance coverage, and medical terminology.

Responsibilities

Determine customer eligibility for life claims and manage ongoing claims by applying contractual provisions, following legal guidelines, and working with technical leadership.
Respond to high volumes of calls from customers and clients.
Respond proactively and empathetically to written and telephone inquiries about life benefits, with supervisory support.
Communicate with customers, beneficiaries, business partners, and employers to gather information for eligibility assessments and ongoing benefit administration.
Respond to inquiries about eligibility, approval or denial determinations, claim status, and continuation or closure of benefits.
Pay covered claims up to $60,000 accurately and efficiently with minimal supervision.
Refer claims to Expert Resources with guidance from technical leadership.
Learn to identify medical records needed to support claim reviews.
Execute customer performance guarantees.
Meet standard timeframes for processing mail, tasks, and outliers.
Follow Group Benefit Solutions and corporate compliance policies, procedures, and best practices.
Complete required GBS and NYL training by designated deadlines.
Respond to telephone and email inquiries clearly, concisely, and promptly in accordance with customer service protocols.