Senior Claims Representative

Location Designation: Fully Remote 

Role Overview:

Reviews, approves or denies routine and claims up to level of authority. Recommends payment or denial of claims over designated authority level. Keeps abreast of claim related legal principles, tax requirements, as well as underwriting rules and procedures. Provides service and claims support to Third Party Administrators, certificate holders, and beneficiaries by responding to inquires as well as analyzing, evaluating and approving, or recommending denial of: Death, Accidental Death, Accelerated Benefits, Dismemberment, and Waiver of Contribution claims. Processes follow-up inquiries on “Pending” claims. Directs investigations on contestable and accidental claims. Prepares/sends correspondence to contract holders, claimants, and various organizations for records. Adheres to Fair Claims Practices regulations, NYL Claim service standards, Delegation of Authority and Corporate policies. Providing customer service for Life, Dismemberment, Accelerated, and Waiver claims. *Approval/denial authority up to $150,000.  

What You’ll Do:

• Reviewing submitted claims to ensure proper guidelines have been followed and eligibility requirements have been met.
• Calculating the appropriate payment for the claims and approves payment of claims within the delegated authority. 
• Manages claims, including referral to management and/or Office of General Counsel.
• Recommends payment or denial of claims over designated authority level.
• Initiates appropriate claim investigations. 
• Communicates with claimants (or their legal representative) and with our Third-Party
• Administrators on all claims related matters. Keeps abreast of claim related legal principles, tax requirements, as well as underwriting rules and procedures.
• May perform claim-related administrative assignments which include preparing claims-related reports and statistics.
• Provides service and claims support to Third Party Administrators, certificate holders, and beneficiaries.
• May be necessary to interact with other Group Membership Departments such as contracts, account managers, and accounting. 
• Participates in projects as required. Strong product knowledge, communication skills and organizational ability. 
• Completes work with a limited degree of supervision.

What You’ll Bring:

• Bachelor’s degree and/or 3+ years Equivalent Claims Experience
• Knowledge of the legal principles, tax requirements, and underwriting rules regarding claims processing. 
• Strong knowledge of life and waiver claims through formal training or considerable on-the-job training. 
• Proficient in Microsoft Word and Excel. 
• Knowledge of medical terminology/anatomy. 
•  Strong organizational skills. 
• Outstanding analytical skills with attention to detail. 
• Strong oral and written communication skills.

It is recommended that all qualified candidates …