• RTX STD Claim Specialist

    MetLife (Aurora, IL)


     

    Once a month in office for meetings

    Key Responsibilities:

    • Independently assess, analyze and render appropriate claim decisions on STD, PML and state claims

    • Clarify functional capacity through independent problem-solving measures and discretion (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability.

    • Adhere to federal and state law to maintain appropriate and timely claim outcomes.

    • Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment.

    • Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel.

    • Articulate and document their rationale for claim direction, possess the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file.

    • Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as clinical staff to obtain additional information on a claim.

    • Determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim.

    • Perform other duties as required.

    Essential Business Experience and Technical Skills:

    Required:

    • High School Diploma

    • 2+ years of short-term disability (STD) experience

    Preferred:

    • Bachelor’s degree

    • Strong communication skills, both written and oral.

    • Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.

    • Strong problem solving and analytical skills.

    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.