MetLife

Job Summary:

Director – Long-Term Disability (LTD) Claims is responsible for overseeing the end-to-end management of LTD claims, ensuring compliance with regulatory requirements, optimizing operational efficiency, and driving best-in-class claims outcomes. This role involves leading a team of claims professionals, developing policies and procedures, managing risk, and collaborating with internal and external stakeholders to enhance claims management processes. This role requires expertise in claims processing, team leadership, and project management to drive continuous improvements and optimize workflows.

Key Responsibilities:

1. Leadership & Team Management:

• Lead, mentor, and develop a team of LTD claims professionals, including, Managers, associate managers, and technical claims specialists.

• Foster a culture of continuous improvement, collaboration, and accountability.

• Provide strategic direction and guidance to ensure the team meets performance metrics and service level agreements.

2. Claims Management Oversight:

• Oversee the evaluation, adjudication, and resolution of LTD claims to ensure fair, accurate, and timely decisions.

• Ensure compliance with regulatory guidelines, insurance policies, and company procedures.

• Monitor claims trends, risk exposure, and potential fraud indicators.

3. Process Improvement & Operational Efficiency:

• Develop and implement best practices to improve claims processing efficiency and accuracy.

• Leverage data analytics and technology to enhance decision-making and claims outcomes.

• Identify and address operational bottlenecks to improve workflow and customer experience.

4. Regulatory & Compliance Management:

• Ensure adherence to federal, state, and local regulations (e.g., ERISA, ADA).

• Work closely with legal and compliance teams to mitigate risks and address regulatory concerns.

• Stay updated on industry changes and regulatory updates impacting LTD claims.

5. Stakeholder Collaboration & Communication:

• Partner with underwriting, legal, actuarial, and customer service teams to ensure alignment on claims strategies.

• Engage with external vendors, medical professionals, and policyholders to facilitate claim resolutions.

• Provide executive leadership with reports on claims performance, trends, and strategic initiatives.

6. Financial & Risk Management:

• Ensure accurate claim payments and decisional forecasting.

• Develop risk mitigation strategies to control claims costs and reduce unnecessary payouts.

Qualifications & Experience:

• Bachelor’s degree in Business, Insurance, Risk Management, or a related field (Master’s preferred).

• 8-10+ years of experience in disability claims management, with at least 5 years in leadership roles.

• Strong knowledge of LTD policies, claims processing, and industry regulations.

• Experience with claims management systems and data analytics tools.

• Project management experience required; PMP certification or Six Sigma a plus.

• Excellent leadership, decision-making, and communication skills.

• Ability to drive process improvements and manage change effectively.