Sr. LTC Appeals Specialist
Location:
Tampa , Florida
Posted:
March 21, 2017
Reference:
42802-en_US

Job Location: United States : Tampa : Florida

 

 

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 is responsible for handling  complex appeals for claimants who have been declined benefit eligibility for LTC either at initial request for benefits or at discharge from a benefit period.

    

 

  • Reviews complex LTC claims appeals by completing a fair, independent assessment, thoroughly reviewing the file and determining the benefit denial was appropriate.
  • Evaluates complex plan provisions, and medical and functional information.
  • Identifies questionable aspects to the claim, determines need for additional information and obtains it.
  • Makes decisions based on available information, writes customized, clear, concise letters with appropriate details to insureds, their representatives or attorneys regarding the decision in a timely manner.
  • Ensures compliance with the customer contract and state regulations.
  • Tracks and follows up on litigation issues for the appeal team.
  • Coaches, directs and develops Appeals Specialists and acts as a training resource to raise individual capabilities.
  • Provides feedback to Appeals Specialists as appropriate.
  • Anticipates, resolves, and responds to high level escalated claim/customer issues.

 

  • Bachelor’s degree
  • 6+ years equivalent experience.
  • Solid business knowledge of Long term care, State laws, and appeal handling.
  • Knowledge of medical procedures and terminology.
  • Ability to read, interpret and explain contracts and long term care plans.
  • Thorough current knowledge of business unit products and services for handling Insurance Department complaints and Non-Litigation and Pre-Litigation Law Department referrals.

 

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 #: 42802 


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

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