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Claim Examiner

Date Posted: Oct 8, 2018

Location: Schenectady, NY, US, 12307

Company: MetLife

Job Location:  Schenectady, NY                                

 

Role Value Proposition: 

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities.  The Global Technology & Operations group (GTO) is a diverse team of engineers, developers, business analysts, claims analysts and project managers with the freedom to create innovative solutions to address core business challenges with MetLife. This role will review, research, and investigate pended General Electric (GE) Group Life claim submissions with multiple coverages and complexity to determine if the claim is payable in accordance with all GE policy provisions.  If payable, determine eligible payee(s) and payment amount(s). If not payable, develop detailed letter of explanation based on said policy provisions and claim documents. Provides customer service with empathy and patience on incoming and outgoing phone inquiries and provides guidance on life claim processes.  In addition, this role will research, determine and calculate benefits and amounts for vested pension and retirement savings benefits in accordance with all GE policy provisions.  Provide appropriate paperwork to be completed based on eligibility for vested benefits.  Submit for payment of benefits upon receipt and review of required documents.  This role will sit on-site with our customer. 

    

Key Responsibilities:

  • Identify and obtain missing information required to evaluate GE Group life claims and input information into a Windows based computer system (BIOS).
  • Interpret GE policy provisions and manually adjudicate GE Group Life claims to make claim determinations.
  • Work directly with the customer and administrative staff to clarify plan provisions and resolve claim discrepancies.
  • Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees.  Provide guidance on claim processes and resolve customer issues swiftly and thoroughly.
  • Actively pursue and follow up on open claims within specified timeframe.
  • Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.
  • Evaluate life claims to identify claim situations requiring referral to Senior Examiner.
  • Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.
  • Maintain production and quality standards.
  • Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training.
  • Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions.
  • Handle inbound and outbound calls needed in regards to Group Life servicing.
  • Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer.
  • Process claims within payment authority.
  • Utilize multiple systems for claim determination.
  • Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.)

 

Essential Business Experience and Technical Skills:

Required:

  • High School Diploma or GED
  • 2-4 years of experience in claims or customer service.
  • Strong data entry skills required.
  • Shares information and engages in candid and open dialogue.  Expresses self well in conversations and via written documents.
  • Outstanding customer service and communication skills both written and verbal

 

Preferred:

 

  • College degree or relevant job experience desirable.
  • Critical thinking in activities requiring analysis, problem solving, investigation, and/or planning.
  • Projects an attitude of service, empathy, and patience to all customers.
  • Ability to deal with people in stressful situations.
  • Ability to work periodic overtime when required.
  • PC knowledge required. (Microsoft Word and Excel)

 

Travel

0-5% 

Business Category

Global Technology and Operations

Number of Openings

1 

 

 

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 #: 99278 


Nearest Major Market: Albany