Group Claims Representative

Location Designation: Fully Remote
Role Overview:
As a Group Claim Representative, you will develop the skills needed to conduct Life Insurance claim investigations, make determinations regarding eligibility for benefits, provide ongoing claim administration, and communicate decisions and status updates. This role will manage a high volume, and attention to detail is important. The Group Claim Representative decisions have a direct impact on customers' well-being and sense of security. The ability to make and effectively communicate decisions within compliance guidelines, while integrating knowledge of customer contracts, GBS Group Operations and corporate compliance are critical for success.
What You'll Do:
• Complete Life claim customer eligibility determinations and manage on-going claims through, applying appropriate contractual provisions, following legal guidelines, and working closely with technical leadership.• Respond to calls from customers and clients, responding to inquiries proactively and empathically regarding life benefits• Communicate with customers, beneficiaries, business partners, and employers, to gather information regarding assessing eligibility and ongoing management of benefits.• With close supervision, respond to written and telephone inquiries from customers, including eligibility, approval/denial determinations, status and continuation or closure of benefits.• Pay all covered claims up to $60,000.00 accurately and efficiently with minimal supervision• Refer claims to Expert Resources with guidance from Technical leadership• Learn to identify medical records needed to assist with claim reviews• Execute on all customer performance guarantees • Adhere to standard timeframes for processing mail, tasks and outliers• Understand Group Benefit Solutions (GBS) and Corporate Compliance, Policies and Procedures and best practices • Complete all GBS and NYL required trainings within designated deadlines• Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
What You'll Bring:
• One year minimum of professional experience strongly preferred• HS Diploma or GED required. Bachelor's degree strongly preferred.• Proficiency with MS Office applications is required (Word, Outlook)• Proven track record of successfully driving results in a complex matrix environment is a plus• Ability to gather information, analyze facts, and draw conclusions• Works with a sense of urgency and is a self-starter with a customer focus mindset• Ability to build and maintain effective relationships• Effective interpersonal, written and verbal communication skills• Excellent planning, time management and organizational skills• Ability to manage multiple and changing priorities.• Knowledge of legal liability, insurance coverage and medical terminology is a plus
Core Competencies:
1. Decision Quality
2. Customer Focus
3. Effective Communication
4. Action Oriented
#LI-AP1
#LI-REMOTE
Pay Transparency
Salary Range: $45,000-$55,000
Overtime eligible: Nonexempt
Discretionary bonus eligible: Yes
Sales bonus eligible: No
Actual base salary will be determined based on several factors but not limited to individual's experience, skills, qualifications, and job location. Additionally, employees are eligible for an annual discretionary bonus. In addition to base salary, employees may also be eligible to participate in an incentive program.
Company Overview
At New York Life, our 180-year legacy of purpose and integrity fuels our future. As we evolve into a more technology-, data-, and AI-enabled organization, we remain grounded in the values that drive lasting impact.
Our diverse business portfolio creates opportunities to make a difference across industries and communities-inviting bold thinking, collaborative problem-solving, and purpose-driven innovation. Here, you'll find the rare balance of long-standing stability and forward momentum, supported by an inclusive team that honors tradition while embracing progress.
As a Fortune 100 mutual company, we offer a place to grow your skills, contribute to meaningful work, and deliver solutions that matter. Your ideas drive what's next, and your growth powers it.
Our Benefits
We provide a full package of benefits for employees - and have unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs. Based on feedback from our employees, we continue to refine and add benefits to our offering, so that you can flourish both inside and outside of work.Click hereto discover more about our comprehensive benefit options or visit our NYL Benefits Site.
Our Commitment to Inclusion
At New York Life, fostering an inclusive workplace is fundamental to who we are and how we serve our communities. We have a longstanding commitment to creating an environment where individuals can contribute their best and succeed together. This foundation is rooted in our core values of humanity and integrity, ensuring that every employee feels valued and supported. By embracing a broad range of perspectives and experiences, we achieve greater success and fulfill our promise of providing financial security and peace of mind to families across all communities. Click here to learn more about New York Life's leadership in this space.
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 the Foundation. We're proud that due to our mutuality, we operate in the best interests of our policy owners. To learn more about career opportunities at New York Life, please visit the Careers page of www.NewYorkLife.com.
Visit our LinkedIn to see how our employees and agents are leading the industry and impacting communities.
Visit our Newsroom to learn more about how our company is constantly evolving to meet our clients' and employees' needs.
Job Requisition ID: 93234