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Once training is complete, employees are to report to the office 1x/month.

Key Responsibilities:

* Manages assigned caseload of initial eligibility files with limited supervision.

* Utilizes critical thinking and independent judgment and analysis to provide timely, balanced, and accurate claims decisions in a time sensitive, compliance driven and fast paced environment.

* Compiles file documentation requiring extensive policy and factual detail.

* Identifies information and resources needed to make initial benefit eligibility determinations, to include review of detailed medical information and other documentation necessary for rendering initial eligibility decision.

* Communicates decisions to policyholders and or their representatives in both verbal and written form.

* Composes highly detailed letters to policyholders and or their representatives outlining status of review and basis of determination.

* Clarifies and reconciles inconsistencies.

* Conducts in depth detailed information-gathering phone calls that obtain medical condition details and other information.

* Engages with various medical and legal resources in situations where warranted.

* Represents MetLife at deposition and trial due to first party litigation environment.

Essential Business Experience and Technical Skills:

Required

* Strong communication skills, both written and oral

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

* Experience using MS office products

* Strong organizational skills.

* High School Diploma/GED and 3-5 years related experience

Preferred

* Bachelor’s Degree

* 2-4 years professional experience

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.