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MetLife · 1 day ago

Long Term Disability Claims Specialist I

United States

Full-time

Remote

Entry Level

$42K/yr - $55K/yr

2+ years exp

MetLife is a leading financial services company dedicated to making a meaningful impact in the lives of customers and communities. The LTD Claims Specialist I evaluates long term disability insurance claims and is responsible for managing caseloads, providing customer service, and ensuring compliance with regulations.

Asset ManagementFinancial ServicesInsuranceLife InsuranceRisk Management

No H1B

Responsibilities

Virtual roles predominately work from a home office with periodic visits to the assigned office as needed for team events, meetings, training, business continuity, etc

Effectively manages some level of oversight an assigned caseload which consists of pending, ongoing/active 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

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

Develop actions plans and identify return to work potential

Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills

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

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

Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed

Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas