The expected outcome of this position is to deliver timely clinical services while meeting case management standards and principles and applicable performance guarantees.
The focus includes enhancement of the quality of claim decisions and facilitation of safe, timely and appropriate return-to-work (RTW) outcomes through the contribution of clinical expertise.
The individuals in this role will be knowledgeable regarding the customer’s business, disability plan design, RTW philosophy and processes. Through effective working partnerships with the Customer, they will identify RTW potential and will coordinate activities to achieve return to work outcomes that are successful for the Customer and employee.
- Manages assigned caseload of complex cases; applies specialized training/knowledge to the assessment of cases; provides technical insight and advice.
Reviews, records, and analyzes medical records and treatment plans data to make claims settlement determination
Compares duration control guidelines and clarifies functional inconsistencies
Provides recommendations to team regarding employee's current or potential functional abilities
Develops goal-focused return-to-work plans
Addresses barriers for return to work
Facilitates communication between employee, physician and employer and partners with all parties to achieve a positive outcome
Follows established claim policies and practices to resolve claims and issues
Performs other related duties as assigned or required
- None. May provide guidance to junior staff members.
- Current state RN licensure
3-5 years of insurance claims experience
3-5 years of clinical nursing experience in a hospital environment.
- Prefer additional experience in Disability/Worker’s Comp, Occupational Health or Rehab Nursing.
Strong verbal and written communication skills
Strong interpersonal and influence skills
Excellent analytical and problem solving skills
Ability to work independently with minimal supervision
Strong customer service skills
Excellent negotiating skills
Proven presentation skills
Ability to reason through, interpret, and apply standardized procedures
Ability to prioritize, effectively manage multiple tasks, and work in a fast paced environment and meet multiple deadlines while maintaining complete and accurate information, which will be updated as changes occur
Ability to be flexible in a changing environment
Desire to take responsibility for own career development
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.
MetLife - 15 months ago
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