Individual Disability Claims Specialist II

About the position

The Individual Disability Claims Specialist II role at MetLife involves managing a caseload of disability claims with limited supervision. The position requires effective communication with various stakeholders, detailed documentation of claims evaluations, and collaboration with external and internal resources to ensure accurate claims determinations. This role is primarily virtual, with occasional in-office meetings, and demands strong analytical and problem-solving skills in a fast-paced environment.

Responsibilities

• Effectively manages an assigned caseload with limited supervision consisting of pending, ongoing, and appeal reviews.
• Provides timely, balanced, and accurate claims reviews, documentation, and recommended decisions in accordance with state and department of insurance regulations.
• Conducts detailed information-gathering telephone calls with insureds or their representatives to obtain necessary details for claim evaluation.
• Documents facts of conversations within the claim file in a timely manner utilizing appropriate detail and professional writing skills.
• Interacts and communicates effectively with insureds, attorneys, brokers, and family members during claim evaluations.
• Compiles file documentation and correspondence requiring extensive policy and factual detail, analyzing information to determine if additional proofs are needed.
• Collaborates with external and internal resources to gather data for well-reasoned claims decisions.
• Clarifies and reconciles inconsistencies during claim evaluations and represents MetLife at depositions and trials when needed.
• Calculates monthly benefits due after elimination period, including COLA, Social Security offsets, and non-routine payments, documenting claim files accordingly.
• Prepares freeform letters to insureds and/or their representatives outlining the status of evaluations and claims determinations.
• Addresses and resolves escalated customer complaints in a timely manner, drafting written responses to complaints when required.

Requirements

• High school diploma.
• Prior experience with independent judgment and decision-making based on available facts.
• 2 years of related professional business experience.
• Demonstrated use of critical thinking and analysis when reviewing information.
• Creative problem-solving abilities in complex situations.
• 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 interactions with high-level professional customers.
• Demonstrated conceptual thinking and risk management skills.
• Strong organizational and time management skills.

Nice-to-haves

• Bachelor's degree.
• 3 to 5 years of related professional business experience.
• Individual Disability Income claims experience.

Benefits

• Equal Employment Opportunity/Disability/Veterans accommodations available.
• Drug-free workplace policy.