Senior Insurance Claims Specialist - Life&Health

Job description

Description and Requirements The Team You Will Join On MetLife’s Global Customer Service and Operations (GCSO) team, customer care is built on trust, empathy, and a commitment to continuous improvement. Whether guiding customers through life’s important moments, solving challenges, or simplifying processes with innovative technology, you’ll help deliver a differentiated experience grounded in operational excellence. Backed by a collaborative team, you’ll play a vital role in strengthening the way we care and advocate for millions worldwide.

Here, making a real difference isn’t just a goal - it’s what we do, one conversation at a time. The Opportunity The Senior Claims Specialist - Life & Health is responsible for delivering fair, timely, and customer-centric claims decisions while driving continuous improvement, digital transformation, and operational excellence across MetLife Romania's Life and Health Claims function. This role ensures that customers receive support when they need it the most, contributing directly to MetLife's purpose of building a more confident future for our customers across Romania.

This is an exciting opportunity to combine claims expertise, customer advocacy, and AI-enabled innovation to help shape the future of claims management and create simpler, faster, and more empathetic customer experiences.

Key Responsibilities

Manage complex life, health, and disability claims end-to-end, from assessment and benefit determination through payment and final resolution. Make sound, well-documented claims decisions and communicate outcomes clearly and empathetically to customers and beneficiaries. Provide technical expertise on complex claims, policy interpretation, and benefit determination, supporting colleagues when needed. Ensure claims are managed in line with policy provisions, regulatory requirements, risk, fraud prevention, KYC/AML, data protection, and internal controls.

Partner with medical advisors, reinsurers, distribution teams, and internal functions to deliver effective, customer-focused outcomes. Monitor claims performance and trends, identify root causes, and drive improvements in quality, efficiency, and customer experience. Identify opportunities to simplify, automate, and digitalize claims processes, using approved AI tools responsibly and critically. Contribute to claims governance, system implementations, automation, and transformation initiatives, sharing best practices across the team.

Required Qualifications

3+ years of experience in Life and/or Health Claims, including managing complex claims. Strong knowledge of insurance products, policy terms, claims assessment, and decision-making. Ability to interpret medical, financial, and legal documentation and make sound, well-supported decisions. Strong analytical, problem-solving, and prioritization skills, with a continuous improvement mindset. Customer-focused approach, balancing customer needs, risk considerations, and business objectives.

Strong ownership, communication, collaboration, and stakeholder management skills, including in sensitive or challenging situations. AI fluency, with the ability to use approved AI and digital tools responsibly, critically evaluate outputs, and identify opportunities for greater efficiency and automation. Intermediate to advanced English and strong Microsoft 365 skills.

Preferred Qualifications

University degree in Medicine, Economics, Law, Finance, Insurance, or another relevant field. Experience leading or participating in digital transformation, process improvement, or claims automation initiatives. Previous experience in AI-powered productivity tools (e.g., Microsoft Copilot, ChatGPT, Claude) and the ability to apply them to enhance operational efficiency and customer outcomes. Lean, Six Sigma, Agile, or other continuous improvement certifications and experience working in cross-functional change initiatives.

A curious, improvement-oriented mindset and enthusiasm for using technology. The expected salary range for this position is 102900 - 137200. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.