Claims Representative
New York Life - Austin, TX

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  • Interpret policy/contract language and understand the variances between the different NYL policy forms.
  • Review, investigate and document State-specific licensure requirements
  • Review new and existing claims for determination of benefits eligibility
  • Coordinate and prepare denial documentation for Office of General Counsel (OGC) as necessary
  • Prepare and review all outgoing daily departmental correspondence
  • Review and document all State-specific compliance issues pertaining to claims.
  • Coordinate materials/information for NYL Actuaries and other departments as needed
  • Respond to inquiries/correspondence from agents, insured, providers of service, and third party vendors
  • Assist Claims Manager in response preparation for State Department of Insurance inquiries or complaints
  • Assist in training of lower-level employees as needed
  • Coordinate monthly billing statements and process release of LTC claim checks
  • Coordinate month-end reporting and vendor billing with accounting
  • Coordinate with GDS in home office to maintain draft registers and draft control measures
  • Perform other duties as required Job Location TX - Austin Department INS - LONG TERM CARE Position Type Full Time AutoReqId 7335BR Required Qualifications •Bachelor’s degree is preferred. Education may be substituted for directly related experience. RN, LVN, or equivalent work experience and four years of previous claims paying experience is preferred.
  • Ability to meet deadlines and handle multiple tasks simultaneously working well under stress; highly proficient in interpretation and application of contract, and benefit requirements affecting claims processing; detailed knowledge of industry and medical terminology, procedure and standards; Must have a working knowledge of related departments and their functions. Requieres excellent verbal and written communication skills and computer skills.
  • Initial salary dependent upon qualifications and experience
  • Internal applicants must be employed with New York Life for at least one year to apply

About this company
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New York Life Insurance has been providing life insurance policies in the Big Apple since it was a tiny seed. While the top mutual life...