Senior Appeals Specialist - Long Term Disability

Job Description

Job Location: Oriskany, NY Alternate Job Location: Virtual

Role Value Proposition:

Global Operations (Global Ops) focuses on creating positive experiences for MetLife customers and helping the company make the best use of its global resources. We’re looking for unique talent with fresh perspectives that can propel innovation. In this role you will be responsible for conducting timely reviews and analyses of adverse benefit determinations on LTD claim files received on appeal and rendering a final determination in accordance with laws and regulations

K ey Responsibilities:

• Ensure quality standards throughout review process, provide technical assistance, and identify trends/improvements that have a direct effect on business goals.
• Reviews high dollar claims and processed.
• Ensures associates are making the right decisions supported by primary data and documentation.
• Reviews and updates systems to ensure completeness.
• Anticipates, responds and resolves escalated inquiries from policyholders, group admin beneficiaries, attorneys, and families.
• Provide technical expertise to case managers for high value or questionable cases.
• Reviews Disability Appeals by completing a fair, independent assessment and a thorough holistic review of the file and by assessing the denial or termination of an LTD claim for accuracy by evaluating plan provisions, medical and vocational information
• Prepares clear and concise written correspondence with claimants, policyholders, and attorneys in a timely manner Articulates and documents the rationale for the appeal decision based on the facts of the claim
• Identifies/address trends/opportunities to support efficiencies and ongoing process improvements
  

Essential Business Experience and Technical Skills:

Required:

• Proficient knowledge of STD, LTD, group disability, workers compensation, ERISA, social security, and state laws. 3 to 5 years of experience
• Proficient customer focus and management.
• Strong knowledge of multiple systems and technology resources
• High School Diploma

Preferred:

• Bachelor’s Degree

Travel

0-5%

“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 .”

MetLife:
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 $600 billion of total assets under management as of December 31, 2019. We are ranked #44 on the Fortune 500 list for 2019. In 2019, we were named to the Dow Jones Sustainability Index (DJSI) for the fourth year in a row. DJSI is a global index to track the leading sustainability-driven companies.
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 below.

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 #: 115112