Short Term Disability Claim Specialist

Role Overview: 

Claim owner and decision-maker. Responsible for administering claims within contractual provisions and internal /external guidelines. Establishes a relationship with claimants in order to understand their perspective on their disability. Using that perspective and other information, identifies the claimant’s functional capacity and leverages that capacity within the context of the contract to support and encourages return to work as appropriate. 

Job Location: Virtual, but must be in a commutable distance from the following office(s):

• Bloomfield, Connecticut
• Oriskany, New York 

Employees will be required to come into the office ONCE A MONTH.

Key Responsibilities:

• Manages overall STD block of claims and possible companion claims to include Statutory plans, Federal, Company, State and other Leave types as required by our group customers or other Federal, State, Local laws
• Creates and executes individual claim action plans, serves as point of contact for the claimant and provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication, and makes claim decisions. Proactively communicates/updates to partners that may be working with the claimant when key events are being considered or have occurred (Closure, RTW, etc.)
• Proactively communicates with the claimant to set expectations, assess medical and non-medical barriers to return to work, and keep him or her fully aware of the status of the claim, including setting expectations with the claimant if other resources (Voc, etc.) will be contacting him/her. Partners with the claimant, specialty resources, and more experienced resources to ensure that each claim has a well-understood plan that is appropriate for the unique situation of each claimant, his or her functional capacity and the prognosis for an increase in that capacity.  
• Meet and Exceed Operational Efficiency goals, Demonstrate Service Delivery and Customer Satisfaction goals, including prioritizing actions, appropriately utilizing resources timely, maintain data integrity through accurate benefit decision and payment
• Accountable for accurate financial decisions on block of claims with financial base benefit amount up to $8000 per week per claim decisions made in accordance with Customer provisions  
• Applies all appropriate provisions of the disability contract to ensure that MetLife’s liability is understood and appropriately applied throughout the life of the claim. Within the context of liability, encourage and support return to work through a variety of programs and methodologies. 
• Performs all other duties as required. 

Essential Business Experience and Key Behaviors, Required: 

• Understands value in building rapport and develops positive working relationships
• Motivated by their interactions with others 
• Quickly grasps information and efficiently solves verbal challenges with strategic thinking 
• Communicates complex verbal and written concepts with ease
• Pays close attention to details, and accounts for details that may be overlooked
• Professionally demonstrate empathy to others
• Provide original insights on familiar subjects  
• Balances task work while adapting to change and exploring new innovative ideas
• Ability to prioritize and maintain quality
• High School Diploma

Key Competencies, Qualifications and Skills, Preferred:

• Associate Degree or higher
• 2 plus years of claims management experience preferably in Healthcare field
• Proficient with Microsoft office software
• Prior STD and Family Medical Leave Act claims knowledge 
• Ability to work independently 
• A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
• 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. 
• Ability to give and receive feedback to/from partners 
• Basic knowledge of medical conditions, treatments, prognosis
• Critical-thinking skills, strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
• Prioritization skills. Ability to balance quantity and quality.