Voluntary Benefits Wellness Claims Specialist

Location Designation: Fully Remote
Group Benefit Solutions deliverscomprehensive insurance and absence management solutions for mid-sized and large companies. Our work fosters a healthier, happier, and more secure workforce, contributing to New York Life's legacy of beingthere when we're needed most. Here, you'll design, implement, and support these solutions directly impacting employees' lives. At our core, we provide financial security and peace of mind to people through our absence, accident, disability, voluntary benefits, and life insurance solutions. Click here to learn more about Group Benefits solutions.
Role Overview:
New York Life Group Benefit Solutions (GBS) continues to expand into the Voluntary Benefits (VB) marketplace. As part of this effort, we are seeking Wellness Claim Specialists to support our VB customers by administering wellness claims-one of the most frequently utilized benefits under our accident, critical illness, and hospital indemnity products. This role focuses on accurate, timely claim adjudication, proactive issue resolution, and exceptional customer service.
What You'll Do:
• Review and process wellness claims (routine preventive care benefits) submitted via phone, portal, or mail.
• Verify enrollment, policy provisions, and annual benefit allowances to determine eligibility.
• Document claim decisions accurately and apply appropriate claim benefits per established procedures.
• Handle basic escalations; resolve customer or client concerns promptly and route complex cases to a VB Claim Manager or Team Leader as appropriate.
• Communicate claim outcomes clearly and professionally to customers and business partners.
• Meet productivity and quality standards by achieving daily/weekly adjudication targets.
• Collaborate with peers and VB Claim Managers to identify trends, share best practices, and resolve recurring issues.
• Support special projects, process improvements, and system enhancements as needed.
• Participate in ongoing training and development to build VB claims knowledge and prepare for progression to higher-level roles.
What You'll Bring:
• High School diploma or GED required; college coursework or degree preferred.
• 1+ years of insurance, healthcare, or customer service experience required.
• Experience in benefits administration or claims preferred.
• Strong attention to detail with the ability to accurately process high volumes of claims.
• Proficiency with Microsoft Office applications (Word, Outlook, Excel).
• Strong verbal and written communication skills with the ability to explain claim outcomes clearly.
• Ability to manage multiple tasks and maintain accuracy in a fast-paced environment.
• Customer-focused mindset with a strong sense of accountability.
• Ability to learn and apply insurance product knowledge, including accident, hospital indemnity, and critical illness wellness benefits.
Pay Transparency
Salary range: $40,000-$52,000
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.
Actual base salary within that range will be determined by several components including but not limited to the individual's experience, skills, qualifications, and job location.In addition to base salary, employees may also be eligible to participate in an incentive program.
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 Diversity Promise
We believe in a diverse workforce because it is our mission to advocate for the financial security and success of people in every community. This is why diversity, equity, and inclusion (DEI) are guiding principles that are embedded in our brand and our culture. Click here to learn more about how we have been recognized for our leadership.
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.
Job Requisition ID: 94555
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