Sr. LTD Claims Specialist
Location: Aurora, IL, US, 60504
Job Location : United States : Aurora : Illinois
Alternate Job Location : United States : Virtual
Role Value Proposition:
Global Technology & Operations (GTO) includes over 17,000 associates across 42 countries Service our customers in operations and global customer call centers where we deliver global support services, including global real estate, global corporate security, and global innovation.This role,for a Sr. LTD Claims Specialist, will provide exemplary customer service by processing a complex case load of 90 100 group disability claims in a timely and accurate manner.
- Independently assess, analyze and render appropriate claim decisions pursuant to certificates on most complex claims.
- Clarify functional capacity through independent problem solving measures and discretion (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability.
- Adhere to federal and state law to maintain appropriate and timely claim outcomes.
- Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment.
- Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel.
- Provide mentoring and/or coaching to less experienced team members, and handle more complex claims.
- Articulate and document their rationale for claim direction, possess the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file.
- Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as clinical staff to obtain additional information on a claim.
- As the sole owner of the LTD claim, determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim.
- Performs other duties as assigned or required.
Essential Business Experience and Technical Skills:
- High School diploma
- 5+ yrs. related experience
- Bachelor’s degree
- 7+ yrs. related experience
- Strong customer satisfaction focus.
- Strong communication skills, both written and oral.
- Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
- Strong problem solving and analytical skills.
- Ability to work independently.
- Comfortable working with multiple priorities in a changing environment.
- Ability to prioritize and maintain quality.
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.