MetLife

Job Location: Virtual                                          

Role Value Proposition:  

Claim owner and decision-maker. Responsible for administering claims within contractual provisions and internal /external guidelines. Establishes a relationship with claimants 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 Responsibilities:  

• Manages overall STD block of claims and possible companion claims to include Statutory plans, Federal, Company, State and other Leave types as required by our group customers or other Federal, State, Local laws
• Creates and executes individual claim action plans, serves as point of contact for the claimant and provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication, and makes claim decisions. Proactively communicates/updates to partners that may be working with the claimant when key events are being considered or have occurred (Closure, RTW, etc.)
• Meet and Exceed Operational Efficiency goals, Demonstrate Service Delivery and Customer Satisfaction goals, including prioritizing actions, appropriately utilizing resources timely, maintain data integrity through accurate benefit decision and payment
• Accountable for accurate financial decisions on block of claims with financial base benefit amount up to $8000 per week per claim decisions made in accordance with Customer provisions  
• Performs other related duties as assigned or required

Essential Business Experience and Key Behaviors, Required: 

• Understands value in building rapport and develops positive working relationships
• Motivated by their interactions with others 
• Quickly grasps information and efficiently solves verbal challenges with strategic thinking 
• Communicates complex verbal and written concepts with ease
• Pays close attention to details, and accounts for details that may be overlooked
• Professionally demonstrate empathy to others
• Provide original insights on familiar subjects  
• Balances task work while adapting to change and exploring new innovative ideas
• Ability to prioritize and maintain quality
• High School Diploma

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