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Appeals Claims Specialist

Date Posted: Aug 11, 2018

Location: Oriskany, FL, US, 33647

Company: MetLife

Director and Below Job Description 

 

Job Location

Oriskany, NY

 

Alternate Job Location

Bloomfield, CT

Tampa, FL

Aurora, IL

Mount Prospect, IL,

Bridgewater, NJ

 

Role Value Proposition:

Conducts timely reviews and analyses of adverse benefit determinations on short-term disability claim files received on appeal and renders final determinations in accordance with ERISA laws and regulations.

Key Responsibilities:

Functional Responsibilities: Conducts reviews and analyses of denied and terminated disability claims for accuracy of determinations by taking into consideration contract provisions, medical, vocational, and employment information. Identifies questionable aspects of the claim to determine the need for additional information, taking into consideration contract provisions and medical and vocational evidence of the claim. . Conducts timely reviews in accordance and compliance with the Employee Retirement Income Security Act of 1974 (ERISA). Responds to inquiries in a timely manner. Prepares clear and concise written correspondence with claimants, policyholders, and attorneys in a timely manner. Tracks and reports information via the Appeal Tracking Database. Identifies opportunities and issues for ongoing improvement of the process. Performs other related duties as assigned or required.

Supervisory Responsibilities: None.

 

Essential Business Experience and Technical Skills:

Conducts reviews and analyses of denied and terminated disability claims for accuracy of determinations by taking into consideration contract provisions, medical, vocational, and employment information.

Identifies questionable aspects of the claim to determine the need for additional information, taking into consideration contract provisions and medical and vocational evidence of the claim.

Conducts timely reviews in accordance and compliance with the Employee Retirement Income Security Act of 1974 (ERISA).

Responds to inquiries in a timely manner.

Prepares clear and concise written correspondence with claimants, policyholders, and attorneys in a timely manner.

Tracks and reports information via the Appeal Tracking Database. Works as a team player with willingness to assist others.

Identifies opportunities and issues for ongoing improvement of the process.

Performs other related duties as assigned or required.

 

Required Qualifications

  • High School Diploma
  • 5+ years of STD or LTD experience
  • Internet based system knowledge
  • Knowledge of ERISA  

 

Preferred Qualifications

  • Knowledge of writing letters
  • Excellent oral and written communication
  • Bachelor’s Degree

 

Travel

0-5%

 

“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 is a proud equal opportunity/affirmative action employer committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. It is MetLife's policy to ensure equal employment opportunity without discrimination or harassment based on 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.

For immediate consideration, click the Apply Now button. You will be directed to complete an on-line profile. Upon completion, you will receive an automated confirmation email verifying you have successfully applied to the job.

Requisition #: 100381 


Nearest Major Market: Tampa