Premium Waiver Claims Examiner

Job Location: United States : New York : Oriskany

Alternate Job Location: Not Applicable : Not Applicable

Work Arrangement: Virtual

Job Location: Commutable distance to Oriskany: New York,

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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 within specified timeframes.

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. Maintain production and quality standards.

8. Utilize internal specialty resources to maximize impact on each file.

9. Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.

10. Understand and use PC programs to increase productivity and performance.

11. Utilize internal specialty resources to maximize impact on each file.

12. Keep up to date on Premium Waiver procedures and attending required training.

Knowledge/Skills/Competencies Required:

• Excellent oral and written communication skills

• Customer service experience in a professional work environment

• Analytical ability and good judgment in evaluating claims

• Strong Data entry skills and PC knowledge (Microsoft Word and Excel)

• 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 work periodic overtime

Knowledge/Skills/Competencies Preferred:

• Life and/or Disability insurance experience
• Knowledge of medical terminology
• College degree or relevant work experience desirable

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:

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.