Ltd Technical Claims Specialist

At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The LTD Technical Claim Specialist is responsible for providing technical assistance and coaching to disability claims professionals. This role partners with the LTD Unit Leader to ensure that individual team members and the team meet all key performance indicators. The LTD Technical Claim Specialist acts as a resource for any claim-related and technical issues as an individual contributor.

Key Responsibilities:

• Effectively partners with the Unit Leaders to meet individual, team, and objective key results (OKR’s)
• Acts as subject matter expert of our processes and procedures to provide technical assistance and coaching to disability claims professionals
• Responsible for working with the Unit Leaders on the development of team members inclusive of providing timely, detailed feedback from claim reviews, as well as responsibility to coach to areas of identified opportunity. Act as LTD subject matter expert.
• Conducts Exceed Authority (EA) reviews, quality, and other block reviews of the team inventory to ensure financial and decisional accuracy training opportunities and claims management guidance to drive continuous improvement. 50-100%- varies based on business and customer needs.
• Responsibility for the development, communication, and coaching of any new or updated procedures to our disability claims professionals.
• Responsible for consistent, detailed analysis of data and reporting to monitor team metrics and quickly identify areas of opportunity and solutions for improved team OKR performance.
• Provides in-service training as needed on any key performance or claim management topics.
• Works with business consultants, business procedures, and training, along with other support areas to resolve system discrepancies to ensure accurate claims payment in partnership with the Unit Leader.
• Effectively works cross-site with peers and leadership to ensure consistency in the claim administration applying risk management options based upon claim facts. Share best practices to drive effective claims management and continuous improvement of our policies and practices.
• May handle a small caseload of the most complex claims if business needs dictate or complete projects as business needs arise. May partner with the Unit Leader to attend required business meetings.
• Effectively collaborate and partner with the Unit Leader to understand the QA proficiency scores and create an action plan for the team. Coach to the opportunities and celebrate the fully proficient behaviors.
• Partners with the Unit Leader to assist with development of the team and oversight on the OKR’s.
• Coordinate and partner with the Unit Leader to attend Multi-Disciplinary Claim Discussion (MCD’s) meetings.

Responsible for all aspects of new hire development for those in the LEAP program. This includes:

• Creation and/or presentation of LEAP training materials
• Updating training materials as needed
• Tracking of file reviews and new hire progress
• Presenting data to LEAP/Core Unit Leaders
• Tracking of file reviews and new hire progress
• Presenting data to LEAP/Core Unit Leaders
• Conducting regular 1:1 with new hires to discuss progress and their developing proficiency level.
• Work with the core team to train to customer variances. Presenting data to LEAP/Core Unit Leaders
• Tracking of file reviews and new hire progress
• Presenting data to LEAP/Core Unit Leaders
• Conducting regular 1:1 with new hires to discuss progress and their developing proficiency level.
• Work with the core team to train to customer variances.

Essential Business Experience and Technical Skills:

Required:

• Extensive knowledge of IDI, STD, LTD, AMS, group disability, Workers Compensation, ERISA, Social Security and state laws
• Strong analytical and decision-making skills with a focus on producing results
• Creative problem-solving abilities and the ability to think outside the box
• Excellent interpersonal and communication skills in both verbal and written form
• Excellent customer service skills proven through internal and external customer interactions
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
• Organizational and time management skills
• Ability to work independently to analyze business trends to create process efficiencies.
• Ability to effectively manage multiple systems and technology resources

Preferred:

• Bachelor’s degree
• 5+ years of LTD/IDI Insurance Claims experience