Individual Disability Claims Specialist II

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 RIIn office once a month for office meetingsKey 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 :
• New hires should live a commutable distance from the site the role is posted in
• High school diploma
• Prior experience with independent judgement and decision making while relying on the available facts.
• 2 Years of related professional business experience.
• Be able to demonstrate the use of critical thinking and analysis when reviewing the information.
• Creative problem-solving abilities when working in grey areas and the ability to think outside the box.
• Excellent interpersonal and communication skills in both verbal and written form.
• Professional freeform business writing skills using clear and concise language and grammar.
• Excellent customer service skills proven through internal and external customer interactions with high level professional customers.
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
• Organizational and time management skills.Preferred :
• Bachelor’s degree
• 3 to 5 years of related professional business experience
• Individual Disability Income claims experience.Equal Employment Opportunity / Disability / VeteransIf 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.