Specialist

• Manages assigned caseload of eligibility files with limited supervision

• Utilizes critical thinking and independent judgment and analysis to provide timely, balanced, and

accurate claims decisions in a time sensitive, compliance driven and fast paced environment

• Compiles file documentation requiring extensive policy and factual detail

• Identifies information and resources needed to make benefit eligibility determinations, to include review of

detailed medical information and other documentation necessary for   rendering ongoing eligibility decision

• Communicates decisions to policyholders and or their representatives/providers in both verbal and written

form

• Composes highly detailed letters to policyholders and or their representatives outlining status of review and

basis of determination when necessary

• Clarifies and reconciles inconsistencies

• Conducts in depth detailed information-gathering phone calls that obtain medical condition details and other

information

• Engages with various medical and legal resources in situations where warranted

• Represents MetLife at deposition and trial due to first party litigation environment