Individual Disability Claims Specialist II
Role Value Proposition:
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The IDI Claims Specialist evaluates individual disability income insurance claims and exercises independent judgment, discretion and critical analysis to reach reasonable claims determinations that are in accordance with contract provisions and time service standards.
- Effectively manages an assigned caseload with limited supervision which consists of pending, ongoing and appeal reviews.
- 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.
- Conducts lengthy detailed information-gathering telephone calls with Insured’s or their representatives to obtain medical condition details, financial details, occupational details and other information pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the facts of the conversation within the claim file in a timely manner utilizing appropriate level of detail and professional writing skills.
- Interacts and communicates effectively with Insureds, attorneys, brokers, and family members during claim evaluation
- Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional proofs are 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 in order to ensure well-reasoned decisions.
- Clarifies and reconciles inconsistencies when gathering information during claim evaluations and represents MetLife at depositions and trials. When needed, collaborates with underwriting department and Fraud Waste and Abuse partners.
- Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Residual Disability and non-routine payments. Documents claim files with monthly payments.
- Prepares freeform letters to insureds and/or their representatives, both during and after completion of claim evaluation, which outlines and support the status of the evaluation and/or claim determination. Frequently engages in conversations with our insureds and/or their representatives, in which it is necessary to demonstrate active listening and conduct information gathering to be able to articulate the claims decision upon the completion of an evaluation, as well as being able to explain pertinent policy language in detail.
- Addresses and resolves escalated customer complaints in a timely and thorough manner. When required, drafts written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to legal counsel.
Essential Business Experience and Technical Skills:
- High school diploma
- 2 years of related professional business experience
- 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 when working in grey areas and the ability to think outside the box.
- Excellent interpersonal and communication skills in both verbal and written form.
- Professional freeform business writing skills using clear and concise language and grammar.
- Excellent customer service skills proven through internal and external customer interactions with high level professional customers.
- Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
- Organizational and time management skills.
- Bachelor’s degree
- 3 to 5 years of related professional business experience
- Individual Disability Income claims experience.
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.
The role is eligible for incentive compensation under the sales incentive plan for your position. MetLife offers a comprehensive benefits program, including healthcare benefits, life insurance, retirement benefits, parental leave, legal plan services and paid time off. All incentives and benefits are subject to the applicable plan terms.
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.