Description and Requirements
Position Summary:
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Global Technology & Operations group (GTO) is a diverse team of engineers, developers, business analysts, claims analysts and project managers with the freedom to create innovative and solutions to address core business challenges with MetLife. This role will work with claimants, physicians, employers, and customers to ensure strict adherence in determining functional abilities. Provides recommendations regarding claimants' current/potential functional abilities and develops goal-focused return-to-work plans.
Job Responsibilities:
- Provides professional medical, technical, consulting advice, and recommendations in support of claims
evaluation, investigation, and assessment for various claims-related departments, while managing assigned
caseload of complex case applying specialized training and knowledge to the assessment of cases and acting
as a resource on clinical and technical issues.
- Conducts complex research, review and analysis of medical records, treatment plans and claim information.
- Provides recommendations regarding claimants' current potential functional abilities and develops
goal-focused return-to-work plans.
- Assess training needs and creates, authors, and presents medical training to claim and business partner
associates.
- Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining
functional abilities.
- Engages claimants, health care providers and employers in return to work potential and planning while
coaching claim specialists on identifying and acting upon return-to-work potential.
- Creates effective requests for medical information which focus on clarifying medical restrictions and
limitations and their impact on work functionality. Performs other related duties as assigned or required
Skills Required:
- Computer navigation skills
- Excellent Keyboarding and data entry speed
- Knowledge about US Culture is preferred.
- Excellent verbal/written communication skills - should be able to read, interpret business documents.
- Excellent analytical and interpersonal skills
- Data gathering ability/ Eye for detail.
- Ability to comprehend and apply varied rules to multiple policies.
- Teamwork/ Managing Self / Adaptability
- Ability to work successfully and perform detail-oriented work in production driven environment.
- Excellent organizational skills
- Proven ability to meet quality and time standards.
- Ability to work on routine/standardized transactions.
- Possess strong knowledge of medical conditions, symptoms, and terminology.
- Required
- Current RN licensure
- 4+ years of experience as an RN with Clinical/Ops Experience
Preferred
- 7+ years Disability claims and/or clinical experience.
- Disability claims experience
- Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
#BI-Hybrid
