IDI Technical Claims Reference Advisor

Description and Requirements
This function exercises substantive, critical, and detailed analysis, independent judgment, and discretion, to reach reasonable claim determinations that are in accordance with contract provisions and time service standards.
Title: IDI Technical Claims Reference Advisor
Location: Fully Virtual
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Principal Responsibilities:

• Manages assigned caseload of Complex IDI claims within a highly autonomous position and with minimal input from manager. Full responsibility for all functions of claims adjudication including; Complaint handling, Directly partnering with the Legal Department, Determining use of resources to include; Field Claim Representatives, Medical Consultants, Financial Consultants, Business Practice Consultants, Occupational Specialist, and any other appropriate resources.
• Provides timely, balanced and accurate claim reviews. Reaches decisions by independent analysis and judgment in a time sensitive and fast-paced environment adhering to time service standards.
• Compiles and evaluates claim documentation and correspondence requiring extensive policy and factual detail.
• High degree of communication skill to effectively explain claim determinations directly to customer /claimant or their representatives in verbal and written form.
• Conducts lengthy detailed information-gathering to obtain details regarding medical condition, financial, and occupational information; and independently determines appropriate handling.
• Partners directly with claimants, physicians, employers, attorneys, field resources, and CPAs to gather data such as medical/occupational/financial information in order to ensure well-reasoned decisions.
• Fully responsible for reviewing and preparing timely responses to any complaint received from a customer / claimant, attorney, Insurance Department, or Presidential Complaint.
• Accountable for identifying and referring appropriate matters to the Legal Department. Partners directly with them in pre-litigation and litigation matters. May be called upon to provide oral testimony on their cases as required including trials.
• Proficiently calculates benefits payable to include; COLA, Social Security Offsets, and non-routine payments. Monitors social security decisions and other disability income benefits.
• Performs other related duties as assigned or required.

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Knowledge/Skills/Competencies Required:

• Possess an extensive understanding of medical, financial and contract/ plan terminology and policy provisions.
• Advanced ability to communicate effectively to a wide range of people; claimants, employers, claim staff, legal, medical, both written and oral.
• Strong analytical and organizational skills in addition to strong verbal and written communication skills. Ability to persuade, interview, empathize, document findings for use by others and format questions.
• Demonstrated problem solving and analytical skills.
• Ability to work independently.
• Comfortable working with multiple priorities in a changing environment. Ability to prioritize, balance time and maintain quality.

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Dimensions:

• Open caseload of approximately 50 active claims

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The salary range for applicants for this position is $93,000.00.
Benefits We Offer
Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!
About MetLife
Recognized on Fortune magazine's list of the 2023 "World's Most Admired Companies" as well as the 2023 Fortune 100 Best Companies to Work For ®, MetLife , through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.
Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by empathy, we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
Equal Employment Opportunity/Disability/Veterans
If you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
$93,000.00