Voluntary Benefits Wellness Claims Specialist

New York Life•McRae-Helena, GA

1d•$40,000 - $52,000•Remote

About The Position

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. New York Life Group Benefit Solutions (GBS) continues to expand into the Voluntary Benefits (VB) marketplace. As part of this effort, we are seeking Wellness Claim Specialists to support our VB customers by administering wellness claims—one of the most frequently utilized benefits under our accident, critical illness, and hospital indemnity products. This role focuses on accurate, timely claim adjudication, proactive issue resolution, and exceptional customer service.

Requirements

High School diploma or GED required; college coursework or degree preferred.
1+ years of insurance, healthcare, or customer service experience required.
Experience in benefits administration or claims preferred.
Strong attention to detail with the ability to accurately process high volumes of claims.
Proficiency with Microsoft Office applications (Word, Outlook, Excel).
Strong verbal and written communication skills with the ability to explain claim outcomes clearly.
Ability to manage multiple tasks and maintain accuracy in a fast-paced environment.
Customer-focused mindset with a strong sense of accountability.
Ability to learn and apply insurance product knowledge, including accident, hospital indemnity, and critical illness wellness benefits.

Responsibilities

Review and process wellness claims (routine preventive care benefits) submitted via phone, portal, or mail.
Verify enrollment, policy provisions, and annual benefit allowances to determine eligibility.
Document claim decisions accurately and apply appropriate claim benefits per established procedures.
Handle basic escalations; resolve customer or client concerns promptly and route complex cases to a VB Claim Manager or Team Leader as appropriate.
Communicate claim outcomes clearly and professionally to customers and business partners.
Meet productivity and quality standards by achieving daily/weekly adjudication targets.
Collaborate with peers and VB Claim Managers to identify trends, share best practices, and resolve recurring issues.
Support special projects, process improvements, and system enhancements as needed.
Participate in ongoing training and development to build VB claims knowledge and prepare for progression to higher-level roles.