Description and Requirements
Position Summary
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 work with claimants, physicians, employers, and customers to ensure strict adherence in determining functional abilities. Provides recommendations regarding claimants' current/potential functional abilities and develops goal-focused return-to-work plans.
Job Responsibilities
- • Provides professional medical, technical, consulting advice, and recommendations in support of claims
evaluation, investigation, and assessment for various claims-related departments, while managing assigned
caseload of complex case applying specialized training and knowledge to the assessment of cases and acting
as a resource on clinical and technical issues.
- • Conducts complex research, review and analysis of medical records, treatment plans and claim information.
- • Provides recommendations regarding claimants' current potential functional abilities and develops
goal-focused return-to-work plans.
- • Assess training needs and creates, authors, and presents medical training to claim and business partner
associates.
- • Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining
functional abilities.
- • Engages claimants, health care providers and employers in return to work potential and planning while
coaching claim specialists on identifying and acting upon return-to-work potential.
- • Creates effective requests for medical information which focus on clarifying medical restrictions and
limitations and their impact on work functionality. Performs other related duties as assigned or required
Education, Technical Skills & Other Critical Requirement
Education
Bachelor's degree (Medical) or diploma with a minimum of 15 years of education.
Experience
(In Years)
Required
- Current RN licensure
- 4+ years of experience as an RN with Clinical/Ops Experience
Preferred
- 7+ years Disability claims and/or clinical experience.
- Disability claims experience
- Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
Technical Skills/other skills
- Computer navigation skills
- Excellent Keyboarding and data entry speed
- Knowledge about US Culture is preferred.
- Excellent verbal/written communication skills - should be able to read, interpret business documents.
- Excellent analytical and interpersonal skills
- Data gathering ability/ Eye for detail.
- Ability to comprehend and apply varied rules to multiple policies.
- Teamwork/ Managing Self / Adaptability
- Ability to work successfully and perform detail-oriented work in production driven environment.
- Excellent organizational skills
- Proven ability to meet quality and time standards.
- Ability to work on routine/standardized transactions.
- Possess strong knowledge of medical conditions, symptoms, and terminology.
Other Critical Requirements Like Voice/ Non-Voice for Insurance Ops
Blended
Complexity Scale: 9/T5C5
#BI-Hybrid
What the Team is Saying
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What We Do
Named one of Fortune’s “World’s Most Admired Companies,” MetLife is leading the global transformation of an industry we’ve defined for more than 150 years. At MetLife, every innovation and line of code is a lifeline for our customers and their families—from victims of natural disasters to people living with disabilities and beyond. With operations in more than 40 markets and leading positions across the globe, MetLife’s building a workforce of diverse and empowered voices that all belong. Join our remarkable journey—one in which you help write the next century of innovation in financial services—because with MetLife, making the world a better place is All Together Possible.
Why Work With Us
At MetLife, you’ll be working for a company whose purpose is to help customers throughout their life’s journey, and often in their most critical time of need. You’ll be a part of developing leading-edge platforms that will have a lasting impact on the lives and well-being of tens of millions of customers.
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Hybrid Workspace
Employees engage in a combination of remote and on-site work.
MetLife's current workplace policies classify roles as Office, Hybrid or Virtual based on the nature of work, encouraging new ways of working together
