Senior Long Term Disability Claims Specialist

Claims Reviewer

Location : Fully Virtual

Key Responsibilities :

Effectively and independently manages an assigned caseload of moderately complex claims which consists of pending and ongoing / active 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

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, health care providers, 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 effectively with both external and internal resources, such as physicians, attorneys, clinical and vocational consultants, as needed, to gather data such as medical / occupational information in order to ensure reasonable, thorough decision

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

Essential Business Experience and Technical Skills :

Required :

Prior experience with independent judgement and decision making while relying on the available facts

Be able to demonstrate the use of critical thinking and analysis when reviewing the information

Creative problem-solving abilities and the ability to think outside the box

Excellent interpersonal and communication skills in both verbal and written form

Excellent customer service skills proven through internal and external customer interactions

Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively

Organizational and time management skills

Ability to effectively manage multiple systems and technology resources

3+ years of LTD / IDI Insurance Claims experience

Preferred : Bachelor's degree

Knowledge of STD / FML, state leave laws, worker's compensation, ERISA, and Social Security

Salary Grade

8M

Travel

0-10%

Business Category

GCSO

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Equal Employment Opportunity / Disability / Veterans

If 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.

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