MetLife

Basic Function
? Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and
state regulatory and/or company plan requirements and established FMLA workflow procedures
? Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee,
physicians office or employer through outgoing calls, email, fax or other supporting systems.
? Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans
and make initial claim decision.
? Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW
confirmation, return phone calls, etc.
? Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
? Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
? The position is expected to do absence management and adjudication on Federal, State and company leaves.
? Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees,
employers/customer and physician’s office
Essential Functions:
? Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
? Analyze and research all discrepancies
? Research & Investigate and resolve outstanding items
? Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
? Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside
resources by email and outgoing calls
? Establish action plans for each file to bring claims to resolution
? Utilize internal and external specialty resources to maximize impact on each claim file
? Use PC programs to increase productivity and performance
? Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
? Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
? Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and
meeting key measures
? Ensure adherence to established attendance schedules
? Close visual activity - viewing a computer terminal and extensive reading
Any other essential function that may occur from time to time as directed by the Supervisor.
Primary Internal Interactions
? UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
? Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
? Subject Matter Expert for the purpose of work thread related issues and escalated transactions
? QCA for the purpose of feedback and internal Performance Guarantee quality audit team
? Trainers for the purpose of Pre-process and Process DCA training
? Disability Customer Advocates for escalation resolution
?
Primary External Interactions
? End customer to be contacted through emails/calls for information gathering/decision update
? Claims specialist & other Stateside Teams on emails/calls
? SME / Trainers at the client end for training
Organizational Relationships
Reports To:
Unit Manager, FMLA Process
Supervises:
Skills
Technical Skills
? Good computer navigation skills
? Good keyboarding speed
? Good knowledge of complete MS Office suite
Process Specific Skills
? Knowledge about the Insurance industry in US
? Knowledge about US Culture
? Knowledge of Insurance principles
Soft skills (Mandatory / Desired)
? Communication skills – should be able to read, interpret
business documents. Good verbal/written communication
? Proficiency in English – Spoken and Written
? Analytical and interpersonal skills
? Escalate issues if required
? Data gathering ability/ Eye for detail
? Team work/ Managing Self / Adaptability
? Ability to work successfully in production driven
environment
? Adaptability to change
? Ability to work on routine/standardized transactions
Desired:
? Self disciplined and result oriented
? Ability to multi task
? Ability to work effectively as part of a team
? Knowledge of Medical Terminology (preferred but not
compulsory)
Preferred:
? Claims, specifically disability, preferred
? Working knowledge of FMLA/Disability/Leave procedures
preferred
? Knowledge of system applications preferred