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Claims Examiner- Life Premium Waiver

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Date Posted: May 5, 2022

Location(s): Oriskany, NY, US, 13424

Company: MetLife

 Premium Waiver Claim Examiner : Oriskany NY

Summary of Responsibilities:

Review, research and investigate new and ongoing Total and Permanent and Premium Waiver claims to determine if claim is payable in accordance with policy provisions.  Initiate investigations to obtain medical and vocational evidence required for approval of claim.  Provide customer service with empathy and patience on incoming and outgoing phone inquiries.     _________________________________________________________________________________

Principal Responsibilities:


  1. Evaluate new and ongoing Total & Permanent (T&P) and Premium Waiver (PW) claims to determine MetLife’s liability.
  2. Interpret policy provisions to determine eligibility and make claim determinations.
  3. Initiate investigations through both company and external contacts (i.e., employees, employers and physicians) to obtain medical and vocational evidence required for approval of claim.
  4. Establish action plans for each file to bring claim to resolution.
  5. Evaluate claims to identify situations requiring referral to Senior Examiner.
  6. Respond to written and/or telephone inquiries from policyholders, employers and physicians to resolve claim issues swiftly and thoroughly.
  7. Actively pursue and follow up on open claims within specified timeframes.
  8. Maintain production and quality standards.
  9. Utilize Intellis, UDS and ACS systems to update and maintain accurate data records.
  10. Utilize internal specialty resources to maximize impact on each file.
  11. Coach new hire Premium Waiver Claim Examiners on procedures and workflow.
  12. Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.
  13. Understand and use PC programs to increase productivity and performance.
  14. Keep up to date on Premium Waiver procedures and attending required training.

     15. Interaction with LTD Case Managers on companion PW and Disability cases.

  1. Coordinate with Life Examiners on all deaths of PW applicants.
  2. Provide additional support with Group Life claims.
  3. 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._________________________________________________________________________________

Knowledge/Skills/Competencies Required:

  • Life and/or Disability insurance experience
  • Knowledge of medical terminology
  • Customer service experience in a professional work environment
  • Analytical ability and good judgment in evaluating claims
  • College degree or relevant work experience desirable
  • Ability to work periodic overtime
  • PC knowledge (Microsoft Word and Excel)
  • Excellent oral and written communication skills
  • Strong data entry skills
  • Ability to adjust and respond positively to multiple demands and shifting priorities
  • Understands the sense of urgency in claims management and business demands; knows when to act quickly and when to give decision more time and thought
  • Ability to plan and organize time and priorities to achieve business results
  • Works collaboratively with others, shares best practices and assists teammates with work
  • Ability to deal with people in stressful situations
  • Consistently demonstrates MetLife’s values
  • Ability to introduce new ideas to improve work processes
  • Uses knowledge of the business and the industry to make sound business decisions, weighing the risks of different courses of action
  • Projects an attitude of service, empathy and patience to all customers
  • Shares information and engages in candid and open dialogue; expresses self well in conversations and written documents
  • Takes personal accountability for follow through on customer commitments
  • Ability to maintain confidentiality






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.



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.



Requisition #: 125377


Nearest Major Market: Utica