MetLife

Job Location: Virtual 

Role Overview:

Claim owner and decision-maker. Responsible for administering claims within contractual provisions and internal /external guidelines. Establishes a relationship with claimants in order to understand their perspective on their disability. Using that perspective and other information, identifies the claimant’s functional capacity and leverages that capacity within the context of the contract to support and encourages return to work as appropriate.

Key expectations:

• Applies all appropriate provisions of the disability contract to ensure that MetLife’s liability is understood and appropriately applied throughout the life of the claim. Within the context of liability, encourage and support return to work through a variety of programs and methodologies.
• Proactively communicates with the claimant to set expectations, assess medical and non-medical barriers to return to work, and keep him or her fully aware of the status of the claim, including setting expectations with the claimant if other resources (Voc, etc.) will be contacting him/her.
• Partners with the claimant, specialty resources, and more experienced resources to ensure that each claim has a well-understood plan that is appropriate for the unique situation of each claimant, his or her functional capacity and the prognosis for an increase in that capacity. 
• Executes individual claim action plans, serves as point of contact for the claimant, and makes claim decisions.
• Manages overall block of assigned claims, including  prioritizing actions,  appropriately utilizing resources,  and  timely and accurate decision. 
• Provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication.
• Proactively updates partners that may be working with the claimant when key events are being considered or have occurred. (closure, RTW, etc.).

Key skills:

• A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
• Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim.
• Basic knowledge of medical conditions, treatments, prognosis
• Critical-thinking skills
• Ability to give and receive  feedback to/from partners
• Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
• Prioritization skills. Ability to balance quantity and quality.

Requirements: 

• Must have 1-2 years of STD claims experience 

Key Competencies, Qualifications and Skills, Preferred:

• Associate Degree or higher
• 2 plus years of claims management experience preferably in Healthcare field
• Proficient with Microsoft office software
• Prior STD and Family Medical Leave Act claims knowledge 
• Ability to work independently 
• An understanding of disability contractual provisions