MetLife · 3 hours ago
IDI Claims Specialist II
United States
Full-time
Remote
Entry, Mid Level
$60K/yr - $70K/yr
2+ years expMetLife is a leading financial services company recognized for its commitment to customer service and community impact. The IDI Claims Specialist evaluates individual disability income insurance claims, exercising independent judgment and critical analysis to ensure reasonable claims determinations in accordance with contract provisions and time service standards.
Asset ManagementFinancial ServicesInsuranceLife InsuranceRisk Management
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
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
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
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
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