Group Life Claim Examiner - Central New York

Claim Examiner - Group Life
Location: Oriskany, NY - TRAINING IN OFFICE

Summary of Responsibilities:

Review, research, and investigate pended Group Life claim submission with multiple coverages and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amount(s). If not payable, develop detailed letter of explanation based on policy provisions and claim documents. Provides customer service with empathy and patience on incoming and outgoing phone inquiries and provides guidance on Life Claim processes.

________________________________________________________________________

Functional Responsibilities:

• Identify and obtain missing information required to evaluate Group Life Claims and input information into a Windows based computer system (BIOS). Interpret policy provisions and manually adjudicate Group Life claims to make claim determinations.
• Work with our customer administrative staff to clarify plan provisions and resolve claim discrepancies. Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees. Provide guidance on claim processes and resolve customer issues swiftly and thoroughly.
• Actively pursue and follow up on open claims within specified timeframe. Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met. Evaluate Life Claims to identify claim situations requiring referral to Senior Examiner. Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.
• Maintain production and quality standards. Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training. Use Microsoft Word and Excel to obtain information required to evaluate the Life Claim.
• Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions.
• Handle outbound calls needed regarding Group Life servicing. Handle customer escalations from Reviewers and solve customer problems via telephone using sound business judgment. Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer.
• Process claims within payment authority. Maintain production and quality standards. Utilize BIOS, GLIF Production, CDF, Calligo, EDCS, Groupfacts, WorkDesk, NetView and Accurint to update and maintain accurate data. Interpret policy provisions and manually adjudicate Group Life claims. Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.)
• Mentor new Claim Examiners on Group Life procedures and workflow. Provide UAT support for system enhancements.

Typical Qualification and Key Competencies:

• Ability to adjust to multiple demands and shifting priorities. Consistently demonstrate the MetLife values. Ability to introduce new ideas to improve work processes.
• Directs action towards achieving goals that are critical to MetLife’s success.
• Uses knowledge of the business and the industry to make the best decisions, weighing the risks of different courses of action. Plans and organizes time and priorities to achieve business results. Works collaboratively with others, shares best practices, and assists teammates with work.
• Projects an attitude of service, empathy, and patience to all customers. Shares information and engages in candid and open dialogue. Expresses self well in conversations and written documents. Takes personal accountability for follow through on customer commitments.
• Strong data entry skills, PC knowledge (Microsoft Word and Excel), and Confidentiality required.
• Ability to work periodic overtime required; can include weekends.
• Excellent oral and written communication skills. Ability to deal with people in stressful situations. Analytical ability and good judgment in evaluating Life Claim submissions. Demonstrated outstanding customer service and communication skills both written and verbal. Desire, willingness and ability to learn and perform in a fast-paced environment.
• Life insurance experience and College degree or relevant job experience desirable.

The wage range for applicants for this position is $47000 - $49000. This role is also eligible for annual short-term incentive compensation. MetLife offers a comprehensive benefits program, including healthcare benefits, life insurance, retirement benefits, parental leave, legal plan services and paid time off. All incentives and benefits are subject to the applicable plan terms.