MetLife · 1 day ago
Complaints & Litigation Specialist
United States
Full-time
Onsite
Mid, Senior Level
$53K/yr - $71K/yr
5+ years expMetLife is one of the world’s leading financial services companies, and they are seeking a Complaints & Litigation Specialist to create positive experiences for customers by investigating and resolving complaints related to Dental claims. The role requires strong analytical skills and exemplary customer service to ensure timely and compliant resolution of grievances and regulatory inquiries.
Asset ManagementFinancial ServicesInsuranceLife InsuranceRisk Management
Responsibilities
Conduct thorough investigations of complaints and grievances, including issues such as Quality of Care, Coverage Disputes, Access to Care, and State Complaints
Review and identify complaint issues in conjunction with insurance plan provisions and applicable regulations
Determine corrective actions and resolution decisions, including claim reprocessing and provider/member reimbursement when applicable
Prepare comprehensive written responses addressing all concerns and corrective actions taken
Respond to telephonic inquiries from members and providers regarding complaint outcomes
Collaborate with internal partner areas such as Claims Operations, Legal, Compliance, Network Development, and SIU
Refer cases to Legal, Litigation, or SIU departments when necessary
Ensure all decisions and correspondence comply with plan contracts and state regulations
Maintain accurate and thorough complaint statistics for reporting and trending purposes
Monitor deadlines to meet time service standards and regulatory requirements
Qualification
Required
Knowledge of claims process
High School Diploma or equivalent
Strong verbal and written communication skills
Proven customer service and conflict resolution abilities
Analytical skills for interpreting, evaluating claims, and analyzing reports & data
Preferred
Minimum 5 years of experience in Dental
Knowledge of Dental terminology, procedures, and group plan contracts
Familiarity with systems such as NOVA, Dental SIR, MetCor, Insight platforms
Experience with MS Office (Excel, Powerpoint, CoPilot) a plus
Advanced knowledge of dental processes, procedure codes, and clinical terminology
Experience handling regulatory complaints
Ability to build relationships across departments and with external stakeholders
Sound business judgment and decision-making skills
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
A retirement pension funded entirely by MetLife
401(k) with employer matching
Group discounts on voluntary insurance products including auto and home
Pet, critical illness, hospital indemnity, and accident insurance
Employee Assistance Program (EAP)
Digital mental health programs
Parental leave
Volunteer time off
Tuition assistance
Company
MetLife
MetLife is a provider of insurance, employee benefits, and financial services .
10001+ employees
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
Represents job field similar to this job
Trends of Total Sponsorships
2025 (164)
2024 (108)
2023 (113)
2022 (155)
2021 (75)
2020 (81)
Funding
Current Stage
Public CompanyTotal Funding
$500M2024-06-20Post Ipo Debt· $500M
2000-04-14IPO
Leadership Team
Michel A. Khalaf
President & CEO, MetLife, Inc.
Koley Corte
Senior Vice President & Chief Marketing Officer - Institutional, Regional, Global Insights+Analytics
Recent News
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