Lead LTD Shu Reassessment Claims Specialist

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 Lead SHU Reassessment Claims Specialist is responsible for independently managing the most complex long-term disability claims while providing technical expertise, coaching, and leadership support across the U.S. LTD organization. Guided by our purpose – always with you, building a more confident future – and our New Frontier strategy focused on stronger growth, attractive returns, and all-weather performance, this is an exciting opportunity to deliver timely, balanced claim outcomes that make a meaningful difference for customers.

In this role, you will apply sound judgment and critical thinking, mentor and develop associates, and partner with leaders on initiatives that improve quality, customer experience, operational performance, and staff development.

Key Responsibilities

Independently manage an assigned caseload of the most complex claims which consists of pending and ongoing/active reviews. Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations. Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination and interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations.

Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available. Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments.

Collaborates effectively with both external and internal resources, such as physicians, attorneys, vocational consultants and CPAs, as needed, to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions. Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and addresses/resolves escalated customer complaints in a timely and thorough manner.

Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas. Serves as an extended leadership team member, participates in new hire onboarding including coaching, mentoring and development, providing direct support to Unit Leaders, and partners with the leadership team to meet project goals related to quality, timely claim outcomes, customer service and staff development and provide detailed, balanced feedback to leadership on individual, team, customer or site performance and offers solutions on opportunities identified.

Required Qualifications

5+ years of LTD/IDI Insurance Claims experience with excellent customer service skills proven through internal and external customer interactions and prior experience with independent judgement and decision making while relying on the available facts/problem solving/critical thinking while having the ability to effectively manage multiple systems and technology resources/Organizational and time management skills.

Preferred Qualifications

Bachelor’s degree and knowledge of STD/FML, state leave laws, worker’s compensation, ERISA, and Social Security. The expected salary range for this position is $64,000 - $80,000 . This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.