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Location: Bloomfield, CT
Job Title: MetLife LTD Claims Specialist- JO# 83746
Independently assess, analyze and render appropriate claim decisions pursuant to certificates. Clarify functional capacity through independent problem solving measures and discretion (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability. Adhere to federal and state law to maintain appropriate and timely claim outcomes. Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment. Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel. Articulate and document their rationale for claim direction, possess the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file. Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as clinical staff to obtain additional information on a claim. As the sole owner of the LTD claim, determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim.
Perform other duties as required.
Key Competencies, Qualifications and Skills, Preferred:
Bachelor’s degree preferred.Strong communication skills, both written and oral. Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning. Strong problem solving and analytical skills. Ability to work independently. Comfortable working with multiple priorities in a changing environment.
Ability to prioritize and maintain quality.
Julie Maclin, Recruiter for MetLife
Application Link: http://jobs.metlife.com/hartford/insurance-claims/jobid7013026-ltd-claims-specialist-jobs
All postings will remain for 60 days unless otherwise noted
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