Claims Associate

Senior Associate, Claims

This is a hybrid position based out of our White Plains, NY office. Team members are expected to work onsite one day per week (Wednesdays), with one additional onsite day per month for team meetings or business activities.

As part of New York Life's Group Membership Association Division, you'll be working with the nation's No. 1 provider of life and disability income insurance solutions for association/affinity programs. Beyond the tailored life and disability income insurance solutions you provide, your work fosters a sense of community and shared support within affinity groups.

The Senior Associate, Claims is responsible for evaluating disability claims and determining liability and eligibility for initial and ongoing benefits. This role independently manages a caseload of approximately 125150 claims of varying complexity while ensuring accurate application of policy provisions, timely claim management, and a high level of customer service. The Senior Associate also adjudicates HIP, Office Overhead, and Critical Illness claims and works closely with claimants, physicians, attorneys, administrators, and other stakeholders to gather information, resolve complex issues, and support sound claim decisions.

Evaluate initial and ongoing disability claims to determine liability and benefit eligibility, accurately interpreting and applying applicable policy provisions to individual claim circumstances.

Independently manage a caseload of approximately 125150 claims of varying complexity, using appropriate resources, research, and sound judgment to support timely and accurate claim decisions.

Review, address, and respond to claim appeals, conducting appropriate research and analysis and clearly documenting the rationale for claim decisions.

Adjudicate HIP, Office Overhead, and Critical Illness claims, identifying and resolving issues through effective research, analysis, and problem-solving.

Communicate clearly and professionally with claimants, physicians, attorneys, administrators, and other stakeholders, providing responsive service and obtaining information needed to effectively manage claims.

Meet established timeliness standards for communications and claim management activities while maintaining accurate, organized, and consistent claim handling practices.

Required Skills

• 57 years of disability claims experience, with demonstrated ability to evaluate and manage claims of varying complexity
• Strong ability to interpret insurance policy provisions and apply them accurately to individual claim situations
• Strong research, analytical, and problem-solving skills, including the ability to identify and use appropriate resources when managing complex claims
• Strong verbal and written communication and customer service skills, with the ability to interact effectively with claimants, physicians, attorneys, administrators, and other stakeholders
• Ability to work independently, manage a substantial caseload and competing priorities, and collaborate effectively in a team environment
• Proficiency with Microsoft Office applications, including Word and Excel

Preferred Skills

• Bachelor's degree
• Experience adjudicating HIP, Office Overhead, and Critical Illness claims
• Experience independently managing a high-volume disability claims caseload
• Experience reviewing claim appeals and performing or validating claim calculations

Salary Range: $81,000-$97,000

Overtime eligible: Exempt

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.