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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.

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 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

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 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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