Job Description

Job Location: 100% Virtual Key Responsibilities: * Effectively and independently manages an assigned caseload of moderately complex claims which consists of pending, ongoing/active 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 * 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: * 3+ years of LTD/IDI Insurance Claims experience * 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 Preferred: * Bachelor's degree * Knowledge of STD/FML, state leave laws, worker's compensation, ERISA, and Social Security At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers. Equal Employment Opportunity/Disability/Veterans If you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug-free workplace.

Job Tags

Similar Jobs