Individual Disability Claims Specialist II - Virtual
Posted on: August 7, 2022
Worki Location: Virtual within a Commutable distance of Tampa
Role Value Proposition:
At MetLife, we seek to make a meaningful impact in the lives of our
customers and our communities. The IDI Claims Specialist evaluates
individual disability income insurance claims and exercises
independent judgment, discretion and critical analysis to reach
reasonable claims determinations that are in accordance with
contract provisions and time service standards.
- Virtual roles predominately work from a home office with
periodic visits to the assigned GCSO office as needed for team
events, meetings, training, business continuity, etc.
- Effectively manages an assigned caseload with limited
supervision which consists of pending, ongoing and appeal
- Provides timely, balanced and accurate claims reviews,
documentation and recommended decisions in a time sensitive and
fast-paced environment and in accordance with state and department
of insurance regulations.
- Conducts lengthy detailed information-gathering telephone calls
with Insured s or their representatives to obtain medical condition
details, financial details, occupational details and other
information pertinent to the evaluation of the claim. Once
telephone calls are completed, you will be required to document the
facts of the conversation within the claim file in a timely manner
utilizing appropriate level of detail and professional writing
- Interacts and communicates effectively with Insureds,
attorneys, brokers, and family members during claim evaluation
- Compiles file documentation and correspondence requiring
extensive policy and factual detail. Analyzes information to
determine if additional proofs are needed to make a reasonable and
logical claims determination based off the information
- Collaborates with both external and internal resources, such as
physicians, attorneys, vocational consultants and CPAs to gather
data such as medical/occupational information in order to ensure
- Clarifies and reconciles inconsistencies when gathering
information during claim evaluations and represents MetLife at
depositions and trials. When needed, collaborates with underwriting
department and Fraud Waste and Abuse partners.
- Proficiently calculates monthly benefits due after elimination
period, to include COLA, Social Security Offsets, and Residual
Disability and non-routine payments. Documents claim files with
- Prepares freeform letters to insureds and/or their
representatives, both during and after completion of claim
evaluation, which outlines and support the status of the evaluation
and/or claim determination. Frequently engages in conversations
with our insureds and/or their representatives, in which it is
necessary to demonstrate active listening and conduct information
gathering to be able to articulate the claims decision upon the
completion of an evaluation, as well as being able to explain
pertinent policy language in detail.
- Addresses and resolves escalated customer complaints in a
timely and thorough manner. When required, drafts written responses
to Department of Insurance and Presidential complaints. Identifies
and refers appropriate matters to legal counsel.
Essential Business Experience and Technical Skills:
- New hires should live a commutable distance from the site the
role is posted in
- High school diploma
- Prior experience with independent judgement and decision making
while relying on the available facts.
- 2 Years of related professional business experience.
- Be able to demonstrate the use of critical thinking and
analysis when reviewing the information.
- Creative problem-solving abilities when working in grey areas
and the ability to think outside the box.
- Excellent interpersonal and communication skills in both verbal
and written form.
- Professional freeform business writing skills using clear and
concise language and grammar.
- Excellent customer service skills proven through internal and
external customer interactions with high level professional
- Demonstrated conceptual thinking, risk management, ability to
handle complex situations effectively.
- Organizational and time management skills.
- Bachelor s degree
- 3 to 5 years of related professional business experience
- Individual Disability Income claims experience.
"At MetLife, we re leading the global transformation of an industry
we ve long defined. United in purpose, diverse in perspective, we
re dedicated to making a difference in the lives of our
MetLife, through its subsidiaries and affiliates, is one of the
world s leading financial services companies, providing insurance,
annuities, employee benefits and asset management to help its
individual and institutional customers navigate their changing
world. Founded in 1868, MetLife has operations in more than 40
countries and holds leading market positions in the United States,
Japan, Latin America, Asia, Europe and the Middle East.
We are one of the largest institutional investors in the U.S. with
$642.4 billion of total assets under management as of March 31,
2021. We are ranked on the Fortune 500 list for 2021. In 2020, we
were named to the Dow Jones Sustainability Index (DJSI) for the
fifth year in a row. DJSI is a global index to track the leading
sustainability-driven companies. We are proud to have been named to
Fortune magazine's 2021 list of the "World's Most Admired
MetLife is committed to building a purpose-driven and inclusive
culture that energizes our people. Our employees work every day to
help build a more confident future for people around the world.
We want to make it simple for all interested and qualified
candidates to apply for employment opportunities with MetLife. For
further information about how to request a reasonable
accommodation, please click on the Disability Accommodations link
MetLife is a proud Equal Employment Opportunity and Affirmative
Action employer dedicated to attracting, retaining, and developing
a diverse and inclusive workforce. All qualified applicants will
receive consideration for employment at MetLife without regards to
race, color, religion, sex (including pregnancy, childbirth, or
related medical conditions), sexual orientation, gender identity or
expression, age, disability, national origin, marital or
domestic/civil partnership status, genetic information, citizenship
status, uniformed service member or veteran status, or any other
characteristic protected by law.
MetLife maintains a drug-free workplace.
Requisition #: 125367
Keywords: MetLife, Brandon , Individual Disability Claims Specialist II - Virtual, Other , Zephyrhills, Florida
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