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Senior Case Management Specialist

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Date Posted: May 6, 2022

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

Company: MetLife



Senior Case Management Specialist    - Location :    Oriskany NY                                                                                                       



Summary of Responsibilities:

Using technical expertise, provide guidance and support in the review, research, and investigation of pended FEGLI Life claim submissions. Provide expertise in claim processing, policies, and procedures to FEGLI Department, internal customers and external customers. Review complex claim referrals to ensure correct determination of claim processing. Responds to verbal and written escalations.


Functional Responsibilities:


         ​​​​​​​​​​​​​​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.

  • Provide technical expertise in responding to referrals and authorizing the handling of questionable cases such as investigations, denials, appeals and referrals to other departments.
  • Respond to all types of Insurance Department complaints and escalated phone calls.
  • Seek legal guidance from the Law Department on complex claims, as well as reviewing responses from the Law Department and ensure the appropriate action.  Represent department for depositions and court cases.
  • Review high dollar claims and process based on Sr Case Management Specialist t authority level up to $750,000. Assign to Unit Leader if above authority.
  • Respond to escalated written and/or telephone inquiries from policyholders, FEGLI Customer Unit, beneficiaries, attorneys, and families of deceased employees.  Provide guidance on claim processes and resolve customer issues swiftly and thoroughly.
  • Ensure government standards are met.
  • Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.
  • Work with our FEGLI customer staff, OPM staff to clarify plan provisions and resolve claim processing discrepancies.
  • Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.  This includes meeting turnaround requirements for work assigned to them, including countersigning, pending work and referrals.
  • Coach and train on FEGLI procedures and workflow including LBO and COLA claims.
  • Provides timely and meaningful feedback to management in regard to performance and quality standards.
  • Maintain the outstanding check report
  • Keep up to date on FEGLI procedures by using the Livelink system and attending required training.
  • Use Microsoft Word and Excel for reports, projects, and to obtain information required to evaluate FEGLI claims.
  • Participate in presentations and projects, including audits.
  • Seek guidance from other MetLife offices, including Tax Department, Legal Consultants, Medical Department, SIU and Compliance.
  • Perform pre and post payment quality reviews for FEGLI staff.
  • Look for trends and offer solutions to eliminate inconsistencies.
  • Update and enhance the quality reports for use by management that encompasses monthly, quarterly, and yearly figures
  • Work with customer workflow designs and process changes as necessary.
  • Partner with FEGLI Managers on researching and preparing data to satisfy all FEGLI claim report requests by utilizing Excel, Word, and/or customer specific formats.
  • Continually monitor and evaluate processes in an effort to promote efficiency improvements.
  • Utilize FEGLI claim system on Power builder, Livelink, EDCS, Excel, Microsoft Word, and Accurint, Inventory Tracking Log, Daily Production Database to update and maintain accurate data.
  • Review claims to validate if overpayment occurred.  Once determined overpayment occurred, contact parties involved via phone, correspondence to determine options of repayment of benefits
  • Review and update overpayment log to ensure recovery is completed.
  • Works with outside law firm on collection of outstanding overpayments, write-offs
  • Collect, analyzes, and uses quality control to diagnose root causes and create and recommend corrective action plans
  • Provide training and mentoring to new or less experienced members of the unit
  • •     Print letters for originals document requests and then mail out the documents from the Oriskany Office
  • •     Open packages from Imaging Vendor that include send backs (Checks and desi bene/foreign docs)
  • •     Handle mail sent directly to the office and returned company checks


Typical Experience and Key Competencies:

  • Strong technical claim knowledge, excellent communication skills both written and verbal, ability to work with people in stressful situations.
  • Strong inter-personal skills including the ability to handle situations with tact and diplomacy.
  • Ability to adjust work schedule as business needs require.
  • Ability to adjust to multiple demands, and shift priorities.
  • Consistently demonstrates the MetLife values.
  • Ability to introduce new ideas to improve work processes.
  • Directs action towards achieving goals that are critical to MetLife’s success.
  • Uses knowledge of the business and the industry to make the best decisions, weighing the risks of different courses of action.
  • Plans and organizes time and priorities to achieve business results.
  • Works collaboratively with others, shares best practices, and assists teammates with work.
  • Projects an attitude of service, empathy, and patience to all customers.
  • Shares information and engages in candid and open dialogue.  Expresses themselves appropriately in conversations and written documents.
  • Takes personal accountability for follow through on customer commitments.
  • Ability to manage projects (PDCA’s, QMS, DIT, RCPS).
  • Data entry skills required.
  • PC knowledge required. (Microsoft Word and Excel)
  • College degree and 3 years Life Claims experience desirable.
  • Ability to work periodic overtime required; can include weekends.
  • Confidentiality required.
  • Analytical ability and good judgment in evaluating life claims submissions.
  • Ability to work independently under minimum supervision and meet deadlines.






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 #: 125455


Nearest Major Market: Utica