Accidental Death and Dismemberment Group Claim Senior Representative

Job description

Location Designation: Fully Remote What You'll Do: - Independently conduct claim eligibility determinations and manage on-going claims for benefits through applying appropriate contractual provisions and following legal guidelines. - Proactively communicate with customers, beneficiaries, business partners, and employers, to gather information regarding eligibility for benefits. - Manage complex claims with minimal supervision, and recognize when assistance from Technical Specialist and/or Team Leader is needed. - Interpret and evaluate death investigation records (police, autopsy, toxicology, forensic investigative reports, foreign documents, medical records, etc.) against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud. - Independently refer claims to medical, legal and other Expert Resources when appropriate. - Demonstrate solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues. - Consistently drive initiatives/efforts to successful and compliant outcomes. - Provide coaching to other employees as needed. - Complete all GBS and NYL req...