Premium Waiver Claims Examiner - 13704

Location: Must live within a commutable distance of the Oriskany NY office (Central NY) Or Bloomfield CT office

Once a month in office for meetings 

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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

Knowledge/Skills/Competencies Preferred:

·         Life and/or Disability insurance experience

·         Knowledge of medical terminology

·         College degree or relevant work experience desirable