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Provide professional medical and technical consulting advice in support of claims evaluation. Develop return-to-work plans and engage with claimants, healthcare providers, and employers to determine functional abilities.
The RTH Clinician Support at MetLife involves providing professional medical, technical, and consulting advice for claims evaluation, conducting research on medical records, developing return-to-work plans, and engaging with healthcare providers and claimants.
Responsible for daily administration and policy support for group dental recordkeeping customers. Processes transactions timely and maintains accurate policy records. Performs intermediate level policy administration duties and consults with supervisor on complex problems. Maintains data in administrative systems, troubleshoots and corrects data issues, and processes demographic and coverage level updates. Completes participant level enrollments and reenrollments for dental products, as well as ancillary support functions.
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The Specialist role in Spanish TPRM involves coordinating activities related to the Global IT Third Party Risk Management Program, conducting vendor risk assessments, responding to risk findings, performing security assessments, providing IT security guidance, and offering expertise in risk mitigation processes.
Undertake claims audits across different lines of business and provide coaching and mentoring to case managers. Analyze data specific to claims and support the implementation of data initiatives. Lead end-to-end risk management relevant to claims and collaborate with stakeholders to drive claims governance best practices.
Key member of the AI security team focusing on securing cloud and AI technologies through the implementation of security controls and monitoring processes. Responsibilities include collaborating with various teams, defining security controls, conducting security reviews, and developing data protection proposals. Required qualifications include experience with AI/ML technologies, cloud platforms, data loss prevention tools, and industry-recognized certifications. Preferred qualifications include additional security certifications, experience with cloud security tools, and strong communication skills.
The Clinical Support Consultant - RN at MetLife provides professional medical advice and recommendations in support of claims evaluation, investigation, and assessment. They work with claimants, physicians, and employers to ensure adherence to determining functional abilities and develop return-to-work plans.
Lead the effort to ensure timely and quality base compensation to brokers and third-party entities. Develop, implement, and revise procedures for compensation initiatives. Analyze payments, build relationships, and maintain effective communication. Requires strong analytical, critical thinking, and technical skills in Excel, Cognos, and MS Office.
Assist in audit work, prepare deliverables, adopt contemporary techniques, support audit leader, maintain relationships with stakeholders, utilize Microsoft Office tools, and demonstrate strong analytical abilities.
The RTH Clinician Support-GG12 role involves managing the Clinical/Quality Assurance department within a disability income insurance organization. Responsibilities include providing support to associates, managing improvement efforts, monitoring performance, participating in presentations, and embracing change initiatives. The role requires 5+ years of related work experience, RN license or CRC certification, disability claims experience, computer navigation skills, and knowledge about US culture.
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