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Lead Long Term Disability Claims Specialist

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Date Posted: Sep 19, 2022

Location(s): Cary, NC, US, 27513 Remote, US, 0

Company: MetLife

Position Location: 100% Virtual

 

Role Value Proposition: 

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Lead LTD Claims Specialist evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the Lead LTD Claims Specialist will be a technical expert and emerging leader who will be responsible for coaching and mentoring new associates as well as participating in projects to drive continuous improvement and improve the customer experience. The Lead LTD Claims Specialist is the highest-level individual contributor managing claims within the LTD organization. The Lead LTD Claims Specialist is responsible for exercising independent judgment, demonstrating critical thinking skills, exemplary customer service skills as well as effective inventory management skills. 

 

Key Responsibilities: 

•Effectively and independently manages an assigned caseload of the most 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, vocational consultants and CPAs, 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

•Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments

•Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination

•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 

•Participates in new hire onboarding including coaching, mentoring and development

•Serves as an extended leadership team member, providing direct support to Unit Leaders, and partners with

the leadership team to meet project goals related to quality, timely claim outcomes, customer service and staff development

•Provides detailed, balanced feedback to leadership on individual, team, customer or site performance and offers solutions on opportunities identified

 

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

•5+ 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

 

Business Category

GCSO

Number of Openings

5

 

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.

 

MetLife:

 

MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits and asset management to help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.

 

We are one of the largest institutional investors in the U.S. with $642.4 billion of total assets under management as of March 31, 2021. We are ranked #46 on the Fortune 500 list for 2021. In 2020, we were named to the Dow Jones Sustainability Index (DJSI) for the fifth year in a row. DJSI is a global index to track the leading sustainability-driven companies. We are proud to have been named to Fortune magazine’s 2021 list of the “World’s Most Admired Companies.”      

 

MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.

 

The wage range for applicants for this position is $49,700 - $64,000. This role is also eligible for annual short-term incentive compensation. MetLife offers a comprehensive benefits program, including healthcare benefits, life insurance, retirement benefits, parental leave, legal plan services and paid time off. All incentives and benefits are subject to the applicable plan terms.

 

We want to make it simple for all interested and qualified candidates to apply for employment opportunities with MetLife.  For further information about how to request a reasonable accommodation, please click on the Disability Accommodations link below.

 

MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

 

MetLife maintains a drug-free workplace.

 


Nearest Major Market: Raleigh