MetLife

The Opportunity

The Absence Management Claims Specialist is responsible for Handle, review, and administer Family & Medical Leave Act / and or Americans with Disabilities Act(ADA) claims and adhere to federal and state regulatory and/or company plan requirements. Establish FMLA/ADA workflow procedures and evaluate against appropriate leave plans and make initial claim decisions.

Complete eligibility decisions during intake call, gather pertinent data when necessary, from employee or other supporting systems as well as perform leave-ups as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, etc. Update systems to accurately reflect leave status and ensure appropriate diary documentation exists. 

Guided by our purpose – always with you building a more confident future – and our New Frontier strategy focused on stronger growth, attractive returns and all-weather performance, this is an exciting opportunity to make a meaningful impact in the lives of our customers and our communities.

Key Responsibilities

• Lead claims intake calls, gather pertinent data when necessary, from employee or other supporting systems as well as perform leave-ups as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, etc. to complete eligibility decisions.
• Create innovative solutions for accurate and timely absence management claims processing.
• Oversee claims eligibility decisions for absence management.
• Manage an individual book of absence management claims.
• Develop meaningful relationships with MetLife policy holders.
• Coordinate all aspects of absence management claims from intake to resolution. 

Required Qualifications

• High school diploma. 
• 1+ yrs. related experience and strong customer satisfaction focus and attention to detail.
• New hires should live a commutable distance from the site the role is posted in.
• This role has mandatory paid training in office starting on May 27th lasting for up to 7 weeks. Candidates must be available and present for all training days.

Preferred Qualifications

• Bachelor’s degree or higher.
• FMLA/ADA/Insurance claims knowledge of process and procedures. 
• Call center experience in an insurance setting.
• Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.