Senior 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 Senior LTD Claim Specialist is responsible for independently evaluating and managing moderately complex long-term disability claims within MetLife’s U.S. Long-Term Disability 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 make a meaningful impact in the lives of our customers and communities.

In this role, you will apply independent judgment, critical thinking, exemplary customer service and effective inventory management to deliver timely, balanced and accurate claim decisions while helping claimants navigate the claims process with clarity and confidence.

Key Responsibilities

• Lead the independent evaluation and reassessment of an assigned caseload of moderately complex ongoing long-term disability claims, including reviews for additional earnings, potential fraud activity, return-to-work capacity and changes in functionality.
• Create timely, balanced and accurate claim reviews, documentation and recommended decisions in a fast-paced environment and in accordance with state and department of insurance regulations. Oversee proactive verbal communication with claimants and their representatives, using empathy and active listening to explain the claim process, benefits and plan provisions and to gather essential medical, occupational and financial information.
• Manage the clarification and reconciliation of inconsistencies identified during claim evaluations, collaborating with Fraud, Waste and Abuse resources as needed.
• Develop accurate monthly benefit calculations following the elimination period, including cost-of-living adjustments, Social Security offsets, rehabilitation return-to-work benefits and other non-routine payments.
• Coordinate timely and detailed written claim communications and file documentation that clearly describe evaluation status, claim determinations and relevant claimant conversations.

Required Qualifications

High School Diploma and 2+ years of LTD or IDI insurance claims experience, applied to independently evaluate complex claim information and make sound, fact-based decisions. Proficiency in managing multiple systems and technology resources to review claim information, document findings and support timely claim determinations. Strong critical thinking, analysis, creative problem-solving, conceptual thinking, risk management, organization and time management skills, with the ability to handle complex situations and competing priorities effectively.

A customer-focused, collaborative and accountable professional who demonstrates excellent verbal and written communication, strong interpersonal skills, sound independent judgment and a commitment to delivering high-quality service.

Preferred Qualifications

Bachelor’s degree Knowledge of STD/FML, state leave laws, worker’s compensation, ERISA, and Social Security The expected salary range for this position is $58,000 - $69,000 .

This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.