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:
Knowledge/Skills/Competencies Preferred:
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
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