Tuesday , January 31 2023

Met Life Careers – Individual Disability Claims Specialist II

Website MetLife

Job Description:

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The IDI Claims Specialist evaluates individual disability income insurance claims and exercises independent judgment, discretion and critical analysis to reach reasonable claims determinations that are in accordance with contract provisions and time service standards.

Job Responsibilities:

  • Effectively manages an assigned caseload with limited supervision which consists of pending, ongoing and appeal reviews.
  • 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.
  • 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.
  • 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.
  • 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.
  • Interacts and communicates effectively with Insureds, attorneys, brokers, and family members during claim evaluation
  • 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.
  • 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.
  • 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.
  • 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.

Job Requirements:

  • Be able to demonstrate the use of critical thinking and analysis when reviewing the information.
  • Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
  • Creative problem-solving abilities when working in grey areas and the ability to think outside the box.
  • Excellent customer service skills proven through internal and external customer interactions with high level professional customers.
  • Excellent interpersonal and communication skills in both verbal and written form.
  • Professional freeform business writing skills using clear and concise language and grammar.
  • Prior experience with independent judgement and decision making while relying on the available facts.
  • High school diploma
  • New hires should live a commutable distance from the site the role is posted in

Qualification & Experience:

  • Individual Disability Income claims experience.
  • 3 to 5 years of related professional business experience
  • 2 Years of related professional business experience.
  • Bachelor’s degree

Job Details:

Company: MetLife

Vacancy Type:  Full Time

Job Location: Tampa, FL, US

Application Deadline: N/A

Apply Here