MetLife

On MetLife’s Global Customer Service and Operations (GCSO) team, customer care is built on trust, empathy, and a commitment to continuous improvement. Whether guiding customers through life’s important moments, solving challenges, or simplifying processes with innovative technology, you’ll help deliver a differentiated experience grounded in operational excellence. Backed by a collaborative team, you’ll play a vital role in strengthening the way we care and advocate for millions worldwide. Here, making a real difference isn’t just a goal - it’s what we do, one conversation at a time.

The Complaint Specialist is responsible for conducting thorough investigations of intricate and/or escalated complaints, grievances, and appeals involving Dental, Life, and Disability claims, including Quality of Care, Coverage Disputes, Access to Care, and State Complaints. This is an exciting opportunity to demonstrate exceptional customer service and conflict resolution skills, coupled with strong analytical abilities and deep expertise in dental, life, or disability products, claims, procedures, and group plan contracts.

• Conduct thorough investigations of intricate and/or escalated complaints, grievances, and appeals involving Dental, Life, and Disability claims, including Quality of Care, Coverage Disputes, Access to Care, and State Complaints.
• Analyze complaint issues in accordance with insurance plan provisions and applicable regulations.
• Determine appropriate corrective actions and resolution decisions, including claim reprocessing and provider/member reimbursements.
• Draft detailed written responses that address all concerns and outline corrective actions taken.
• Collaborate with internal departments such as Claims Operations, Legal, Compliance, Network Development, SIU, and Clinical teams to resolve complex issues.
• Escalate cases to Legal, Litigation, or SIU when appropriate.
• Ensure all decisions and correspondence comply with plan contracts and state regulatory requirements.
• Respond to telephonic inquiries from members and providers regarding complaint outcomes.
• Monitor case load deadlines to meet time service standards and regulatory requirements.
• Perform other related duties as assigned.

• High School Diploma or equivalent.
• Excellent verbal and written communication skills.
• Proven success in customer service and conflict resolution.
• Strong analytical skills for interpreting dental records and evaluating claims.
• Subject Matter Expert (SME) in dental, life, or disability terminology, procedures, or group plan contracts.

• Minimum of 8 years’ experience in Dental, Life, and/or Disability customer service or claims.
• SME-level proficiency with systems such as DPA, Catalyst, and dental claims platforms.
• Expert knowledge of processes, procedure codes, and clinical terminology.
• Ability to build strong relationships across departments and with external stakeholders.
• Excellent business judgment and decision-making skills.

The expected salary range for this position is $54,100 - $72,100. This role may also be eligible for annual short-term incentive compensation and stock-based long-term incentives. All incentives and benefits are subject to the applicable plan terms.