Job Description

The Opportunity

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. If payable, determine eligible payee(s) and payment amount(s). If not payable, develop detailed letter of explanation based on policy provisions and claim documents. Provides customer service with empathy and patience on incoming and outgoing phone inquiries and provides guidance on life claim processes.

How You'll Help Us Build a Confident Future (Key Responsibilities)

• Work with our customer administrative staff to clarify plan provisions and resolve claim discrepancies.

• Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees. Provide guidance on claim processes and resolve customer issues swiftly and thoroughly.

• Actively pursue and follow up on open claims within specified time frame.

• Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.

• Evaluate life claims to identify claim situations requiring referral to Senior Examiner, law department and medical department.

• 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.

• Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions.

• Handle outbound calls needed in regards to Group Life servicing.

• Handle customer escalations from Examiner and solve customer problems via telephone using sound business judgment.

• Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer.

• Process complex claims within payment authority.

• Utilize BIOS, GLIF Production, CDF, Calligo, EDCS, Group Facts, WorkDesk, NetView and Accurint to update and maintain accurate data.

• Identify and obtain missing information required to evaluate complex Group life claims such as rival claims, denials, accidental death & dismemberment claims and input information into a Windows based computer system (BIOS).

• Interpret policy provisions and manually adjudicate complex Group Life claims to make claim determinations.

• Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.).

• Handle more complex claims.

• Provide UAT support for system enhancements.

What You Need to Succeed (Required Qualifications)

• Ability to adjust to multiple demands and shifting priorities.

• Consistently demonstrates the MetLife values.

• Ability to introduce new ideas to improve work processes.

• Directs action towards achieving goals that are critical to MetLife's success.

• Uses knowledge of the business and the industry to make the best decisions, weighing the risks of different courses of action.

• Plans and organizes time and priorities to achieve business results.

• Works collaboratively with others, shares best practices, and assists teammates with work.

• Projects an attitude of service, empathy, and patience to all customers.

• Shares information and engages in candid and open dialogue. Expresses self well in conversations and written documents.

• Takes personal accountability for follow through on customer commitments.

• Strong data entry skills required.

• PC knowledge required. (Microsoft Word and Excel)

• Ability to work periodic overtime required; can include weekends.

• 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.

• Life insurance experience required.

• 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 independently under minimum supervision and meet deadlines.

• Ability to make independent decisions with minimum senior referrals.

What Can Give You an Edge (Additional Skills)

• College degree or relevant job experience desirable.

Equal Employment Opportunity/Disability/Veterans

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.

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