Job Description

General Information City/Cities Oriskany, Tampa State(s) Florida, New York Country United States Working Schedule Full-Time Work Arrangement Virtual Commutable Distance Required Yes Relocation Assistance Available No Posted Date 10-Jan-2024 Job ID 1349

Description and Requirements

Job Location : Virtual but must be commutable to Oriskany, New York or Tampa, Florida offices. TRAINING WILL BE IN PERSON.

Role Summary:

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The LTD Claims Specialist evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the LTD Claims Specialist is required to exercise independent judgment, critical thinking skills, exemplary customer service skills as well as effective inventory management skills.

Key Responsibilities:

• Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators. 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, 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. Interacts and communicates effectively with claimants, customers, 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.
• Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and addresses/resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas. Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.

Essential Business Experience and Technical Skills:

Required:

• New hires should live a commutable distance from the site the role is posted in.
• 1-3 years of LTD claims processing experience with prior experience with independent judgement and decision making while relying on the available facts with the use of critical thinking and analysis when reviewing the information
• Creative problem-solving abilities and the ability to think outside the box and organizational/time management skills, excellent interpersonal/communication skills in both verbal and written form, and excellent customer service skills proven through internal/external customer interactions

Preferred:

• Bachelor's degree

Equal Employment Opportunity/Disability/Veterans

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