Specialist

Basic Function
 Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and
state regulatory and/or company plan requirements and established FMLA workflow procedures
 Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee,
physicians office or employer through outgoing calls, email, fax or other supporting systems.
 Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans
and make initial claim decision.
 Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW
confirmation, return phone calls, etc.
 Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
 Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
 The position is expected to do absence management and adjudication on Federal, State and company leaves.
 Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees,
employers/customer and physician’s office

Essential Functions:
 Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
 Analyze and research all discrepancies
 Research & Investigate and resolve outstanding items
 Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
 Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside
resources by email and outgoing calls
 Establish action plans for each file to bring claims to resolution
 Utilize internal and external specialty resources to maximize impact on each claim file
 Use PC programs to increase productivity and performance
 Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
 Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
 Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and
meeting key measures
 Ensure adherence to established attendance schedules
 Close visual activity - viewing a computer terminal and extensive reading
Any other essential function that may occur from time to time as directed by the Supervisor.

Skills
Technical Skills
 Good computer navigation skills
 Good keyboarding speed
 Good knowledge of complete MS Office suite
Process Specific Skills
 Knowledge about the Insurance industry in US
 Knowledge about US Culture
 Knowledge of Insurance principles
Soft skills (Mandatory / Desired)
 Communication skills – should be able to read, interpret
business documents. Good verbal/written communication
 Proficiency in English – Spoken and Written
 Analytical and interpersonal skills
 Escalate issues if required
 Data gathering ability/ Eye for detail
 Team work/ Managing Self / Adaptability
 Ability to work successfully in production driven
environment
 Adaptability to change
 Ability to work on routine/standardized transactions
Desired:
 Self disciplined and result oriented
 Ability to multi task
 Ability to work effectively as part of a team
 Knowledge of Medical Terminology (preferred but not
compulsory)
Preferred:
 Claims, specifically disability, preferred
 Working knowledge of FMLA/Disability/Leave procedures
preferred
 Knowledge of system applications preferred
Education Requirements
Graduate with at least 15 years of education.
Work Experience Requirements
Minimum 3-4 years of experience in a transactional, blended process of insurance or related industry with
relevant experience of working in a business environment (preferred but not compulsory)

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 ranked #44 on the Fortune 500 list for 2019. In 2019, we were named to the Dow Jones Sustainability Index (DJSI) for the fourth year in a row. DJSI is a global index to track the leading sustainability-driven 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.

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.