Group Life Claim Examiner Central New York 2 3 25

$41,600 - $47,000/Yr

MetLife - East Syracuse, NY

Full-time

East Syracuse, NY

Insurance Carriers and Related Activities

About the position

Global Customer Service and Operations serves MetLife's customers around the world, fulfilling their servicing, underwriting, policy administration and claims needs. We are guided by our purpose, putting the customer at the center of everything we do. As one team, we enable global consistency while addressing local needs to best support our markets. And, just like our customers are at the center, so are our people. Our teams' customer journey mindset ultimately fuels a contemporary customer experience, differentiating MetLife in the market.

Responsibilities

• Review, research, and investigate pended Group Life claim submission with multiple coverages and complexity to determine if claim is payable in accordance with various policy provisions.
• Determine eligible payee(s) and payment amount(s) if the claim is payable.
• Develop detailed letter of explanation based on policy provisions and claim documents if the claim is not payable.
• Provide customer service with empathy and patience on incoming and outgoing phone inquiries and provide guidance on life claim processes.
• Identify and obtain missing information required to evaluate Group life claims and input information into a Windows based computer system (BIOS).
• Interpret policy provisions and manually adjudicate Group Life claims to make claim determinations.
• Work with customer administrative staff to clarify plan provisions and resolve claim discrepancies.
• Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees.
• Actively pursue and follow up on open claims within specified timeframe.
• Manage and organize work to meet multiple deadlines and competing priorities.
• Evaluate life claims to identify claim situations requiring referral to Senior Examiner.
• Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.
• Maintain production and quality standards.
• Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training.
• Use Microsoft Word and Excel to obtain information required to evaluate the life claim.
• Handle outbound calls needed regarding Group Life servicing.
• Handle customer escalations from Reviewers and solve customer problems via telephone using sound business judgment.
• Process claims within payment authority.
• Utilize various systems to update and maintain accurate data.
• Initiate investigations to determine validity of Group Life claims.
• Potentially mentor new Claim Examiners on Group Life procedures and workflow.

Requirements

• New hires should live a commutable distance from the site the role is posted in.
• Training will be in person for this role. Candidates must be willing to be in office (Oriskany NY) for training (February 3rd to April 18th, Monday through Friday, 8 AM to 4:30 PM).
• Strong data entry skills, PC knowledge (Microsoft Word and Excel), and confidentiality required.
• Excellent oral and written communication skills.
• Ability to deal with people in stressful situations.
• Analytical ability and good judgment in evaluating life claim submissions.
• Demonstrated outstanding customer service and communication skills both written and verbal.
• Desire, willingness and ability to learn and perform in a fast-paced environment.
• Ability to work periodic overtime required; can include weekends.
• Ability to plan and organize time and priorities to achieve business results.

Nice-to-haves

• Previous Life insurance experience, claims experience, or relevant job experience.
• Ability to adjust to multiple demands and shifting priorities.
• Consistently demonstrate the MetLife values.
• Ability to introduce new ideas to improve work processes.
• College degree (Associates or higher) is desirable.

Benefits

• Comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability.
• Company-paid life insurance and legal services.
• 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.
• Employee Assistance Program (EAP) and digital mental health programs.
• Parental leave, volunteer time off, tuition assistance and much more.