Appeals Specialist Long Term Care Claims
MetLife 3.91,818 reviews - Tampa, FL
Full-time, Temporary

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Job Title:

Appeals Specialist - Long Term Care Claims

Job ID:

71627

Location:

Florida

Full/Part Time:

Full-Time

Regular/Temporary:

Regular

Job Location

Tampa, FL

Job Description

Job Summary:

Reviews LTC appeals of long-term care benefit denials by completing a fair, independent assessment and thorough review of the file and determining the benefit denial by evaluating plan provisions, and medical and functional information. Identifies questionable aspects to the claim to determine the need for additional information and requesting the information when appropriate.

Makes decisions based on available information and writes custom, clear, concise letters with appropriate details to insureds, their representatives or attorneys regarding decision in a timely manner.

Identifies opportunities for improvement to process, or feedback to business partners for training opportunities.

Functional Responsibilities:
  • Manages caseload of complex cases; applies specialized training/knowledge to the assessment of cases
  • Reviews medical records, and analyzes data to make benefit appeal determination
  • Follows established claim policies and practices to resolve issues.

Job Requirements

Requirements:
  • Registered or Licensed Practical Nurse with at least 5 years experience; or without nursing degree , must have a inimum of 5 years experience with medical / clinical benefit decision making role in insurance industry.
Preferred Qualifications:
  • Proven assessment skills and professional judgment
  • Ability to evaluate many and varied factors to arrive at accurate decisions
  • Excellent verbal and written communication skills
  • Demonstrated ability to compose professional and concise letters
  • Experience with writing detailed letters to customers and their representatives
  • Experience with telephonic communication with clients as needed.
  • Ability to manage workload with minimal supervision / excellent time management skills
  • Computer literacy, especially Microsoft Office, and typing skills.

Experience Required

Five to Seven Years

Education Required

Bachelors Degree Preferred

Business Category

Americas Region

Job Category

Claims

Salary Grade

29

Number of Openings

1

Equal Employment Opportunity

MetLife is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

How To Apply

For immediate consideration, click on the Apply Now button below. You will be directed to complete an on-line profile which may take 15 – 20 minutes to complete. Upon completion, you will receive an automated confirmation email verifying you have successfully applied to the job.

About this company
3.91,818 reviews
Don't accuse New England Life Insurance of a regional bias. The company, which operates as New England Financial, provides insurance and...