What are the responsibilities and job description for the Individual Disability Claims Specialist II position at MetLife Services and Solutions, LLC?
Description and Requirements
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The IDI Claims Specialist evaluates individual disability income insurance claims and exercises independent judgment, discretion and critical analysis to reach reasonable claims determinations that are in accordance with contract provisions and time service standards.
Job Location : Must be commutable distance to MetLife Office - Tampa FL, Bloomfield CT, Aurora IL, Cary NC, Oriskany NY (Central NY) Bridgewater NJ, Clarks Summit PA, Warwick RI
In office once a month for office meetings
Key Responsibilities :
- Virtual roles predominately work from a home office with periodic visits to the assigned GCSO office as needed for team events, meetings, training, business continuity, etc.
- Effectively manages an assigned caseload with limited supervision which consists of pending, ongoing 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.
- Conducts lengthy detailed information-gathering telephone calls with Insured's or their representatives to obtain medical condition details, financial details, occupational details and other information pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the facts of the conversation within the claim file in a timely manner utilizing appropriate level of detail and professional writing skills.
- Interacts and communicates effectively with Insureds, attorneys, brokers, and family members during claim evaluation
- Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional proofs are needed to make a reasonable and logical claims determination based off the information available.
- Collaborates with both external and internal resources, such as physicians, attorneys, vocational consultants and CPAs to gather data such as medical / occupational information in order to ensure well-reasoned decisions.
- Clarifies and reconciles inconsistencies when gathering information during claim evaluations and represents MetLife at depositions and trials. When needed, collaborates with underwriting department and Fraud Waste and Abuse partners.
- Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Residual Disability and non-routine payments. Documents claim files with monthly payments.
- Prepares freeform letters to insureds and / or their representatives, both during and after completion of claim evaluation, which outlines and support the status of the evaluation and / or claim determination. Frequently engages in conversations with our insureds and / or their representatives, in which it is necessary to demonstrate active listening and conduct information gathering to be able to articulate the claims decision upon the completion of an evaluation, as well as being able to explain pertinent policy language in detail.
- Addresses and resolves escalated customer complaints in a timely and thorough manner. When required, drafts written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to legal counsel.
Essential Business Experience and Technical Skills :
Required :
Preferred :
Benefits We Offer
Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical / prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!
About MetLife
Recognized on Fortune magazine's list of the 2024 "World's Most Admired Companies", Fortune World's 25 Best Workplaces™ for 2024, as well as the 2024 Fortune 100 Best Companies to Work For ®, MetLife , through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.
Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by empathy, we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
Equal Employment Opportunity / Disability / Veterans
If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
