Job Description

Job Opportunity

Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR, West Des Moines, IA office Once a month in office for meetings

Key Responsibilities

Partners with the STD Unit Leader to analyze and identify barriers for the success and efficiency of their team. Supports and guides assigned team member to ensure that they have the knowledge and skills, tools, and resources to be successful in achieving those expectations by delivering on commitments, timely return of phone calls, clear communication, accuracy of decisions and financial accuracy

Drives Claim Management Accuracy and Customer Centricity through support of the Pre-QA Program, claim file reviews and call monitoring auditing claim file reviews to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance

Accountable for reviews and approves key decisions made by team member(s) within authority limit including financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates other income/offsets in accordance with Customer's plan/policy

Managing operation efficiency goals and provides positive reinforcement to team members that is directly linked to their behaviors and performance objectives and maintains data integrity. Performs other related duties as assigned or required

Essential Business Experience and Technical Skills

Required:

• A comprehensive understanding of the disability contractual provisions, especially the definition of disability
• Ability to coach and mentor members of the team
• Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim
• Basic knowledge of medical conditions, treatments, prognosis
• Critical-thinking skills
• Ability to give and receive feedback to/from partners
• Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
• Prioritization skills. Ability to balance quantity and quality
• Ability to partner with internal/external customers

Preferred:

• Associate Degree
• 2 plus years of claims management experience preferably in healthcare field
• 5 plus years of management
• Proficient in Microsoft Word/Excel

Key Competencies, Qualifications and Skills

* Prior STD, state leave and/or Family Medical Leave Act claims knowledge preferred.

* Strong communication skills, both written and oral.

* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.

* Strong problem solving and analytical skills.

* Ability to work independently

* Ability to multitask, comfortable working with multiple priorities in a changing environment.

* Ability to prioritize and maintain quality

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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