MetLife

Job Responsibilities

* Provides professional medical, technical, consulting advice, and recommendations in support of claims

evaluation, investigation, and assessment for various claims-related departments, while managing assigned

 caseload of complex case applying specialized training and knowledge to the assessment of cases and acting 

 as a resource on clinical and technical issues.

 * Conducts complex research, review and analysis of medical records, treatment plans and claim information.

* Provides recommendations regarding claimants’ current potential functional abilities and develops

 goal-focused return-to-work plans.

 * Assess training needs and creates, authors, and presents medical training to claim and business partner

 associates.

 * Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining 

 functional abilities.

 * Engages claimants, health care providers and employers in return to work potential and planning while 

 coaching claim specialists on identifying and acting upon return-to-work potential.

 * Creates effective requests for medical information which focus on clarifying medical restrictions and 

limitations and their impact on work functionality. Performs other related duties as assigned or required

 Education, Technical Skills & Other Critical Requirement

 Education

 Bachelor’s degree (Medical) or diploma with a minimum of 15 years of education.

 Experience 

 (In Years)

 Required

 * Current RN licensure
 * 4+ years of experience as an RN with Clinical/Ops Experience

 Preferred

 * 7+ years Disability claims and/or clinical experience.
 * Disability claims experience
 * Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).

 Technical Skills/other skills

 * Computer navigation skills
 * Excellent Keyboarding and data entry speed
 * Knowledge about US Culture is preferred.
 * Excellent verbal/written communication skills - should be able to read, interpret business documents.
 * Excellent analytical and interpersonal skills 
 * Data gathering ability/ Eye for detail. 
 * Ability to comprehend and apply varied rules to multiple policies.
 * Teamwork/ Managing Self / Adaptability 
* Ability to work successfully and perform detail-oriented work in production driven environment.
 * Excellent organizational skills
 * Proven ability to meet quality and time standards.
* Ability to work on routine/standardized transactions.
 * Possess strong knowledge of medical conditions, symptoms, and terminology.