Premium Waiver Claims Examiner

  • Company: MetLife
  • Location: Oriskany, New York
  • Posted: May 10, 2017
  • Reference ID: 56161-en_US

Job Location: United States : Oriskany : New York            

 

 

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 evaluate, investigate and process Premium Waiver and Total and Permanent Disability Claims in accordance with plan provisions and MetLife procedures in a timely manner. 

  

 

  • Evaluate new and ongoing Total & Permanent (T&P) and Premium Waiver (PW) claims to determine MetLife’s liability.
  • Interpret policy provisions to determine eligibility and make claim determinations.
  • Make determinations on T&P payout claims up to $50,000 and Premium Waiver claims up to $500,000.
  • Initiate investigations through both company and external contacts (i.e., employees, employers and physicians) to obtain medical and vocational evidence required for claim decision.
  • Establish action plans for each file to bring claim to resolution.
  • Evaluate claims to identify situations requiring referral to Senior Examiner.
  • Respond to written and/or telephone inquiries from policyholders, employers and physicians to resolve claim issues swiftly and thoroughly.
  • Handle all stop, credit and reissue payment on returned and outstanding checks.
  • Proactively interact with internal and external customers.
  • Interact with LTD DCAS on companion PW and Disability cases.
  • Handle Special Handle customers, such as Performance Guarantees, to ensure claims are completed in accordance with the specified customer requirement and agreement provisions.
  • Perform post mortem reviews.
  • Perform other related duties as assigned or required. 

 

  • High School Diploma
  • 2-3 years of insurance claims experience.

 

Operations : Claims

 

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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.” 

 

 

MetLife is a proud equal opportunity/affirmative action employer committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. It is MetLife's policy to ensure equal employment opportunity without discrimination or harassment based on race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

MetLife maintains a drug-free workplace.

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Requisition #: 56161 

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