Lead Long Term Disability Change in Definition Claims Specialist

Description and Requirements
Role Value Proposition:
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Lead LTD Change in Definition (CID) Claims Specialist (CS) evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards at critical transition points in the LTD lifecycle. In this role, the Lead LTD CID CS is required to exercise independent judgment, critical thinking, exemplary customer service, and effective inventory management skills while managing a complex CID caseload, conducting transition reviews when the definition of disability transitions, typically after 24 months of benefits, that assess earnings capacity, functional status, and the claimant's ability to perform any gainful occupation. Ongoing eligibility is evaluated through analysis of functional changes, return to work potential, compliance with plan requirements, and suitability for vocational rehabilitation. In addition, the role supports overall claim quality by mentoring and coaching peers as needed and modeling best practices in documentation, communication, and decision making.
Job Location: 100% Virtual
Key Responsibilities:

• Effectively and independently manages an assigned caseload of complex claims within the change in definition (CID) lifecycle
• 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
• Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions.
• Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations
• Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
• Collaborates effectively with both external and internal resources, such as physicians, attorneys, clinical and vocational consultants, as needed, to gather data such as medical/occupational information to ensure reasonable, thorough decisions
• Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed.
• Serves as an extended leadership team member, participates in new hire onboarding including coaching, mentoring and development, providing direct support to Technical Claim Specialists & Associate Managers, and partners with the leadership team to meet project goals related to quality, timely claim outcomes, customer service, staff development and provide detailed, balanced feedback to leadership on individual, team, customer or site performance and offers solutions on opportunities identified.

Essential Business Experience and Technical Skills:
Required:

• Prior experience with independent judgement and decision making while relying on the available facts
• Be able to demonstrate the use of critical thinking and analysis when reviewing the information
• Creative problem-solving abilities and the ability to think outside the box
• Excellent interpersonal and communication skills in both verbal and written form
• Excellent customer service skills proven through internal and external customer interactions
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
• Organizational and time management skills
• Ability to effectively manage multiple systems and technology resources
• 5+ years of LTD/IDI Insurance Claims experience

Preferred:

• Bachelor's degree
• Knowledge of STD/FML, state leave laws, worker's compensation, ERISA, and Social Security

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 customers.
The expected salary range for this position is $64,000 - $80,000. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.
Benefits We Offer
Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces™, as well as the Fortune 100 Best Companies to Work For®, 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 individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.
Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics").
If you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.
$64,000 - $80,000