Premium Waiver Claims Examiner - 6024

Description and Requirements
Location: Must live within a commutable distance of the Oriskany NY office (Central NY)
Title: Premium Waiver Claim Examiner
LOB/Department: Institutional/Life Product Management
Reports to: Unit Manager - Premium Waiver
_____________________________________________________________________
Summary of Responsibilities:
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. Initiate investigations to obtain medical and vocational evidence required for approval of claim. Provide customer service with empathy and patience on incoming and outgoing phone inquiries. _____________________________________________________________________
Principal Responsibilities:
1. Evaluate new and ongoing Total & Permanent (T&P) and Premium Waiver (PW) claims to determine MetLife's liability.
2. Interpret policy provisions to determine eligibility and make claim determinations.
3. 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.
4. Establish action plans for each file to bring claim to resolution within specified timeframes.
5. Evaluate claims to identify situations requiring referral to Senior Examiner.
6. Respond to written and/or telephone inquiries from policyholders, employers and physicians to resolve claim issues swiftly and thoroughly.
7. Maintain production and quality standards.
8. Utilize internal specialty resources to maximize impact on each file.
9. Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met.
10. Understand and use PC programs to increase productivity and performance.
11. Utilize internal specialty resources to maximize impact on each file.
12. Keep up to date on Premium Waiver procedures and attending required training.
Knowledge/Skills/Competencies Required:
• Excellent oral and written communication skills
• Customer service experience in a professional work environment
• Analytical ability and good judgment in evaluating claims
• Strong Data entry skills and PC knowledge (Microsoft Word and Excel)
• Ability to adjust and respond positively to multiple demands and shifting priorities
• Understands the sense of urgency in claims management and business demands; knows when to act quickly and when to give decision more time and thought
• Ability to plan and organize time and priorities to achieve business results
• Works collaboratively with others, shares best practices and assists teammates with work
• Ability to work periodic overtime
Knowledge/Skills/Competencies Preferred:
• Life and/or Disability insurance experience
• Knowledge of medical terminology
• College degree or relevant work experience desirable
The salary range for applicants for this position is $50,000 - $52,000.
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 2024 "World's Most Admired Companies", Fortune World's 25 Best Workplaces™ for 2024, as well as the 2024 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.
$50,000 - $52,000