MetLife

Key Responsibilities: 

• Effectively and independently manages an assigned caseload of moderately complex claims which consists of ongoing/active claims that require reevaluation for potential additional earnings, fraud activity, return to work capacity and change in functionality. 
• 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
• 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
• Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed.
• Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments
• Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination

Essential Business Experience and Technical Skills:

Required:

• Prior experience with independent judgement and decision making while relying on the available facts
• Be able to demonstrate the use of critical thinking and analysis when reviewing the information
• 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
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
• Organizational and time management skills
• Ability to effectively manage multiple systems and technology resources
• Some college
• 2+ years of LTD/IDI Insurance Claims experience

Preferred:

• Bachelor’s degree
• Knowledge of STD/FML, state leave laws, worker’s compensation, ERISA, and Social Security