Be an early applicantLess than 25 applicants

Company

MetLife · 4 hours ago

Individual Disability Claims Specialist II

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

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Asset ManagementFinancial Services

H1B Sponsor Likely

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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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Business writing skillsCustomer service skillsTime management skillsRisk managementDisability Income claims experienceProfessional business experience

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.

Benefits

Comprehensive health plan that includes medical/prescription drug and vision

Dental insurance

No-cost short- and long-term disability

Company-paid life insurance

Legal services

Retirement pension funded entirely by MetLife

401(k) with employer matching

Group discounts on voluntary insurance products including auto and home

Pet insurance

Critical illness insurance

Hospital indemnity insurance

Accident insurance

Employee Assistance Program (EAP)

Digital mental health programs

Parental leave

Volunteer time off

Tuition assistance

Company

MetLife

Glassdoor

3.9

MetLife is a provider of insurance, employee benefits, and financial services .

Founded in 1868

New York, New York, USA

10,001+ employees

http://www.metlife.com

H1B Sponsorship

MetLife has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (61)

2022 (165)

2021 (96)

2020 (78)