Claim Examiner
Location:
Schenectady , New York
Posted:
August 15, 2017
Reference:
73481-en_US

Job Location: Schenectady, NY

 

 

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 Review, research, and investigate pended Group Life claim submission with multiple coverages and complexity to determine if claim is payable in accordance with various policy provisions

  • Identify and obtain missing information required to evaluate Group life claims and input information into a Windows based computer system (BIOS).
  • Interpret policy provisions and manually adjudicate Group Life claims to make claim determinations.
  • Work directly with the customer and administrative staff to clarify plan provisions and resolve claim discrepancies.
  • Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees.  Provide guidance on claim processes and resolve customer issues swiftly and thoroughly.
  • Actively pursue and follow up on open claims within specified timeframe.
  • Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.
  • Evaluate life claims to identify claim situations requiring referral to Senior Examiner.
  • Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.
  • Maintain production and quality standards.
  • Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training.
  • Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions.
  • Handle outbound calls needed in regards to Group Life servicing.
  • Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer.
  • Process claims within payment authority.
  • Utilize multiple systems for claim determination.
  • Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.)
  • Coach new Claim Examiners on Group Life procedures and workflow.

 


 

Required:

  • High School Diploma
  • 2-4 years of experience in claims or customer service.

Preferred:          

  • Bachelor’s degree
  • Strong communication skills, both written and oral.
  • Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
  • Strong problem solving and analytical skills
  • Projects an attitude of service, empathy, and patience to all customers.
  • Shares information and engages in candid and open dialogue.  Expresses self well in conversations and via written documents.
  • Takes personal accountability for follow through on customer commitments.
  • Strong data entry skills required.
  • Ability to deal with people in stressful situations

[[6m]] 

 

0-5%

 

Global Technology and Operations

1

 

 

At MetLife, we’re leading the global transformation of an industry we’ve long defined. United in purpose, diverse in perspective, we’re dedicated to making a difference in the lives of our customers.” 


A little about us:
MetLife offers life insurance, disability income insurance, car insurance, employee benefits and more.

Know someone who would be interested in this job? Share it with your network.