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Long Term Disability Claims Specialist II

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MetLife

Dec 17

Applications are closed

  • Job
    Full-time
    Junior & Mid Level
  • Customer Relations
  • United States
    Remote

Requirements

  • Required:
  • Prior experience with independent judgement and decision making while relying on the available facts
  • Be able to demonstrate the use of critical thinking and analysis when reviewing the information
  • Creative problem-solving abilities 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
  • Preferred:
  • Bachelor's degree
  • 1-3 years of LTD/IDI Insurance Claims experience

Responsibilities

  • Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators
  • Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations
  • Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan 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 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, attorneys, brokers, and family members during claim evaluations
  • Compiles file documentation and correspondence requiring extensive policy 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, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions
  • Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
  • Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments
  • Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination
  • Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas

FAQs

Is this position fully remote?

Yes, this position is 100% virtual within the U.S.

What does the Long Term Disability Claims Specialist II do?

The specialist evaluates long-term disability insurance claims in accordance with plan provisions and ensures timely and accurate processing.

What qualifications are required for this role?

Required qualifications include experience with independent judgment and decision-making, critical thinking skills, excellent communication skills, and strong customer service abilities. A bachelor’s degree and 1-3 years of LTD/IDI Insurance Claims experience are preferred.

What type of claims will I be managing?

You will be managing moderately complex long-term disability claims, including pending, ongoing, and appeal reviews.

How is performance evaluated for this position?

Performance is evaluated based on meeting key performance indicators and demonstrating consistency in decision-making.

What kind of training will I receive?

Specific training details are not provided, but expect training related to claims processing, customer service, and regulatory compliance.

What customer interactions will I have?

You will have frequent verbal communication with claimants and their representatives, providing updates, gathering information, and addressing customer complaints.

What is the salary range for this position?

The salary range for applicants for this position is between $41,600 and $65,300.

What benefits does MetLife offer?

MetLife offers a comprehensive health plan, dental and vision insurance, company-paid life insurance, a retirement pension, 401(k) matching, paid parental leave, and various employee assistance programs.

What types of skills are essential for this role?

Essential skills include critical thinking, effective problem-solving, organizational skills, and excellent verbal and written communication abilities.

Will I be required to work weekends or nights?

The job description does not specify any required weekend or night work, but typical business hours are expected.

How does MetLife support employee well-being?

MetLife supports employee well-being through health programs, financial wellness resources, and various workplace benefits, including mental health support and tuition assistance.

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MetLife

Finance
Industry
10,001+
Employees
1868
Founded Year

Mission & Purpose

We live in a time of unprecedented change. A time when economies, regulations, and social safety nets are all in flux. Customers around the globe have told us they’re overwhelmed by the pace of change and are looking for a trusted partner to help them manage life’s twists and turns. MetLife is committed to being that partner. That’s why we’re transforming our business: Delivering greater value for the people we serve by becoming a simpler, more focused, and future-facing company. We’ll be introducing new ways to meet our customers’ evolving needs, with flexible products; simpler, more intuitive experiences and a range of new services. MetLife. Navigating life together. MetLife, Inc. (NYSE: MET), through its subsidiaries and affiliates (“MetLife”), 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 markets globally and holds leading positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.

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