Lead Short Term Disability Claim Specialist

The Opportunity

Claim owner and decision-maker. Requiring experience in working and handling Short Term Disability Claims and concurrent Absence leaves. 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/leave. 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. These team members will be assigned to support a variety of customers and teams based on the staffing needs on any given day.

How You’ll Help Us Build a Confident Future (Key Responsibilities)

• Provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication. 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.
• Applies all appropriate provisions of the disability contract and/or statutory requirements 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.
• 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.
• Manages overall block of assigned claims, including prioritizing actions, appropriately utilizing resources, and timely and accurate decision. Executes individual claim action plans, serves as point of contact for the claimant, and makes claim decisions. Proactively updates partners that may be working with the claimant when key events are being considered or have occurred. (Closure, RTW, etc.).
• Senior will provide feedback based on claim reviews.
• Senior will be leaned on to help coach and take on more complex cases based on their expertise.
• Senior will be working across platforms and reviewing multiple plan designs.

What You Need to Succeed (Required Qualifications)

• A comprehensive understanding of the disability contractual provisions, especially the definition of disability, as well as concurrent absence and PML/PFL leaves.
• Knowledge of Legacy and Catalyst platforms.
• 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.
• Willingness to support and learn multiple customers and ambiguity with daily assignments
• Must have a minimum of 1 years Short Term Disability Experience.

What Can Give You an Edge (Additional Skills)

• Bachelor’s Degree
• Proficient in Microsoft Word/Excel
• Some college or degree preferred.
• Prior STD 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.
• Ability to work across platforms and plan designs.
• Ability to manage through constant change.