MetLife

Location – Virtual

Required to be in office once a month if within commutable distance of a MetLife office.

Key Responsibilities:  

·       Effectively manages some level of oversight an assigned caseload of Life and Disability cases which consists of pending claims, ongoing/active claims and appeal reviews.  The Claim Specialist will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators

·       Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.

·       Develop actions plans and identify return to work potential for Long Term Disability claimants

·       Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions.   These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim.  Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills

·       Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations 

·       Compiles file documentation and correspondence requiring extensive policy and factual detail.  Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available

·       Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.

·       Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with resources as needed

·       Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.

·       Proficiently calculates life and disability benefits due to beneficiaries and claimants

·       Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination.

·       Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.

Essential Business Experience and Technical Skills:

Required:

·       High School Diploma

·       Minimum 2 years of experience in claims review & processing experience

·       Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning

·       Creative problem-solving abilities and the ability to think outside the box

·       Excellent interpersonal and communication skills in both verbal and written form

·       Excellent customer service skills proven through internal and external customer interactions

·       Organizational and time management skills 

Preferred:

·       Bachelor’s degree