MetLife Career Opportunities – Lead Long Term Disability Claims Specialist

Website MetLife

Job Description:

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Lead LTD Claims Specialist evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the Lead LTD Claims Specialist will be a technical expert and emerging leader who will be responsible for coaching and mentoring new associates as well as participating in projects to drive continuous improvement and improve the customer experience. The Lead LTD Claims Specialist is the highest-level individual contributor managing claims within the LTD organization. The Lead LTD Claims Specialist is responsible for exercising independent judgment, demonstrating critical thinking skills, exemplary customer service skills as well as effective inventory management skills.

Job Responsibilities:

  • Effectively and independently manages an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews
  • 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
  • Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations
  • Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
  • Collaborates effectively with both external and internal resources, such as physicians, attorneys, vocational consultants and CPAs, as needed, to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions
  • 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

Job Requirements:

  • Excellent interpersonal and communication skills in both verbal and written form
  • Excellent customer service skills proven through internal and external customer interactions
  • Organizational and time management skills
  • 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
  • Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
  • Ability to effectively manage multiple systems and technology resources
  • Creative problem-solving abilities and the ability to think outside the box
  • 5+ years of LTD/IDI Insurance Claims experience
  • Bachelor’s degree
  • Knowledge of STD/FML, state leave laws, worker’s compensation, ERISA, and Social Security

Job Details:

Company:  MetLife

Vacancy Type:  Full Time

Job Location: Utica, NY, US

Application Deadline: N/A

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