New York Life Insurance Company · 1 day ago

Senior Claims Representative

United States

Full-time

Remote

Mid, Senior Level

$40K/yr - $70K/yr

3+ years exp

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Responsibilities

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims ProcessingLegal PrinciplesTax RequirementsUnderwriting RulesMicrosoft WordMicrosoft ExcelMedical TerminologyClaims Experience