Job Description

Premium Waiver Claims Examiner Location Remote :

General Information City/Cities Oriskany State(s) New York Country United States Working Schedule Full-Time Work Arrangement Virtual Commutable Distance Required Yes Relocation Assistance Available No Posted Date 02-Jan-2024 Job ID 1211

Description and Requirements

Location: New Hires Should live within a commutable distance of the Oriskany NY office (Central NY)

Reports to: Unit Manager - Premium Waiver

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Summary of Responsibilities:

Review, research and investigate new and ongoing Total and Permanent and Premium Waiver claims to determine if claim is payable in accordance with policy provisions. Initiate investigations to obtain medical and vocational evidence required for approval of claim. Provide customer service with empathy and patience on incoming and outgoing phone inquiries. _____________________________________________________________________

Principal Responsibilities:

1. Evaluate new and ongoing Total & Permanent (T&P) and Premium Waiver (PW) claims to determine MetLife's liability. 2. Interpret policy provisions to determine eligibility and make claim determinations. 3. Initiate investigations through both company and external contacts (i.e., employees, employers and physicians) to obtain medical and vocational evidence required for approval of claim. 4. Establish action plans for each file to bring claim to resolution within specified timeframes. 5. Evaluate claims to identify situations requiring referral to Senior Examiner. 6. Respond to written and/or telephone inquiries from policyholders, employers and physicians to resolve claim issues swiftly and thoroughly. 7. Maintain production and quality standards. 8. Utilize internal specialty resources to maximize impact on each file. 9. Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met. 10. Understand and use PC programs to increase productivity and performance. 11. Utilize internal specialty resources to maximize impact on each file. 12. Keep up to date on Premium Waiver procedures and attending required training.

Knowledge/Skills/Competencies Required:

• Excellent oral and written communication skills
• Customer service experience in a professional work environment
• Analytical ability and good judgment in evaluating claims
• Strong Data entry skills and PC knowledge (Microsoft Word and Excel)
• Ability to adjust and respond positively to multiple demands and shifting priorities
• Understands the sense of urgency in claims management and business demands; knows when to act quickly and when to give decision more time and thought
• Ability to plan and organize time and priorities to achieve business results
• Works collaboratively with others, shares best practices and assists teammates with work
• Ability to work periodic overtime
• Strong attention to detail

Knowledge/Skills/Competencies Preferred:

• Life and/or Disability insurance experience
• Knowledge of medical terminology
• College degree or relevant work experience desirable

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.

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.

Job Tags

Permanent employment, Full time, Work experience placement, Work at office, Remote work, Relocation package, Shift work,

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