Sr. PW Claims Examiner

  • Company: MetLife
  • Location: Oriskany, New York
  • Posted: April 10, 2017
  • Reference ID: 51582-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 review, research and investigate new and ongoing Total and Permanent and Premium Waiver claims to determine if claim is payable in accordance with policy provisions.      



  • Oversee small to medium technology projects and/or phases of projects.
  • Review business needs, translate into business specifications, and manage projects through testing and deployment.
  • Represent area in system enhancements and design activities.
  • Provide updates to business leadership regarding project status and the application and implementation of technology.
  • Determine specific business application requirements to address varied business needs and analyses and designs solutions to meet those needs.
  • Monitor the progress of initiatives and milestones to ensure timeliness and deliverables are met.
  • Manage critical relationships with Vendor, IT, Consultants, internal end users, and business customers/leadership.
  • Provide information to end users to help resolve problems as well as develop detailed work plans, schedules, project estimates, resource plans, and status reports.
  • 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.
  • Initiate investigations through both company and external contacts (i.e., employees, employers and physicians) to obtain medical and vocational evidence required for approval of claim.
  • 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.
  • Actively pursue and follow up on open claims within specified timeframes.
  • Utilize Intellis, UDS and ACS systems to update and maintain accurate data records.
  • Utilize internal specialty resources to maximize impact on each file.
  • Coach new hire Premium Waiver Claim Examiners on procedures and workflow.
  • Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.
  • Interaction with LTD Case Managers on companion PW and Disability cases and Life Examiners on all deaths of PW applicants.


  • Bachelor’s degree
  • Life and/or Disability insurance experience
  • Knowledge of medical terminology
  • Analytical ability and good judgment in evaluating claims
  • Ability to build a simplified message from complex data
  • Intermediate to advanced knowledge of Access, SQL, relational database architecture, or other relevant query tools
  • Technical Documentation: System Interface Specifications, Business writing skills
  • Excellent oral and written communication skills
  • .


Operations : Claims




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 #: 51582 

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