Job Description

Location Virtual, but must be commutable to the Tampa, FL office. Training is in-office for a minimum of two weeks. Once training is complete, employees are expected to come into the office once a month or as needed by the business. Key Responsibilities Effectively and independently manages an assigned caseload of, and make claims decisions on, moderately complex claims which consists of pending, ongoing, and appeal reviews. Provides timely, balanced, and accurate claims reviews, documentation, and decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations. Serve as the face of the company in providing frequent, proactive verbal communication with our claimants, customers and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits, and other pertinent policy provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information, and any other information that may be pertinent to the Claims Specialist’s evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills. Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during the Claim Specialist’s claim evaluation. Compiles file documentation and correspondence requiring extensive policy analysis and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available. Collaborates with both external and internal resources, such as physicians, attorneys, vocational consultants, and CPAs to gather data such as medical/occupational information to ensure the Claims Specialists claim decisions are well-reasoned and thorough. Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources as needed. Identifies offsets and proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, Residual Disability, and non-routine payments. Provides timely and detailed written communication during the claim evaluation, which outlines and support the status of the evaluation and/or claim determination. Addresses and resolves escalated customer complaints in a timely and thorough manner, including drafting written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to litigation support partners. May represent MetLife at depositions and trials. Essential Business Experience and Technical Skills Required Prior experience with independent judgement and decision making. Critical thinking and analysis skills when reviewing information. Creative problem-solving abilities when working in grey areas and the ability to think outside the box. Excellent interpersonal and communication skills in both verbal and written form. Excellent customer service skills proven through internal and external customer interactions. Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively. Organizational and time management skills. Ability to effectively manage multiple systems and technology sources. 2+ years of IDI or LTD insurance claims experience. Preferred Bachelor’s degree Equal Employment Opportunity/Disability/Veterans If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug‑free workplace. #J-18808-Ljbffr MetLife

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