New York Life Insurance Company Associate - Group Claims - Accidental Death & Dismemberment in Pittsburgh, Pennsylvania
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.
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.
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 Guaranteesand 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
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
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 ourFoundation (https://www.newyorklife.com/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 visitLinkedIn (https://www.linkedin.com/company/newyorklife/) , ourNewsroom (https://www.newyorklife.com/newsroom/) and theCareers (https://www.newyorklife.com/about/careers/) page of www.NewYorkLife.com .
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