Summary of Responsibilities:
Claim Specialists are responsible for timely and accurate communication, information gathering, and rendering decisions on Long-term Disability (LTD) claims to which they have been assigned according to provisions of LTD certificates.
The job entails communicating 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.
Claim Specialists are accountable for approximately 90 – 100 claims at any given time.
Claim Specialists perform their work with limited guidance from Sr. Claim Specialists and supervisory personnel.
Claim Specialists will be routinely evaluated for increases in their authority levels.
Claim Specialists are expected to articulate and document their rationale for claim direction and may do so without higher level input, which includes the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file.
They will utilize tools independently and accurately to identify work to be completed across their entire claim block.
They will analyze the entire block of claims, including all tasks, and based on their knowledge of individual claims prioritize what requires more immediate work even when a particular activity falls outside of generally known priorities.
They will develop an action plan and identify the Likely Claim Progression including identifying the return to work potential.
Claim Specialists will utilize their judgment and problem solving acumen about what resources to involve on each claim (including clinical staff), gain resource perspectives based on resources’ area of expertise, and then render a decision as the sole owner of that claim.
Claim Specialists are required to problem solve for identifying a claimant’s functional capacity and ensuring that their action plan, resource use, and timing results in quality decision making and excellent customer service.
They will utilize CMG which provides an overview of high level topics, factors to consider in the administration of claims, and examples of claim situations.
Independently assess, analyze and render appropriate claim decisions pursuant to certificates.
Clarify functional capacity through problem solving measures (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.
3-5years disability claims experience preferred.
Bachelor degree preferred.
Demonstrated ability in the following areas:
Strong communication skills, both written and oral.
Critical thinking in activities requiring analysis, investigation, and 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.
Three to Five Years
Bachelors Degree Preferred
Number of Openings
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.
MetLife - 21 months ago
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