Group Life Claim Examiner

Description and Requirements

Global Customer Service and Operations serves MetLife’s customers around the world, fulfilling their servicing, underwriting, policy administration and claims needs. We are guided by our purpose, putting the customer at the center of everything we do. As one team, we enable global consistency while addressing local needs to best support our markets. And, just like our customers are at the center, so are our people. Our teams’ customer journey mindset ultimately fuels a contemporary customer experience, differentiating MetLife in the market.

Job Title: Group Life Claim Examiner

Location: Central New York – Virtual with in person training. All candidates must be located within a commutable distance of Oriskany, New York.

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:

• Virtual roles work from a home office with periodic visits to the assigned GCSO office as needed for team events, meetings, training, business continuity, etc.
• 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.)
• Potentially mentoring new Claim Examiners on Group Life procedures and workflow. Provide UAT support for system enhancements.

Typical Qualification and Key Competencies:

Required:

• New hires should live a commutable distance from the site the role is posted in.
• Training will be in person for this role. Candidates must be willing to be in office (Oriskany NY) for training (February 3rd to April 18th, Monday through Friday, 8 AM to 4:30 PM.
• Strong data entry skills, PC knowledge (Microsoft Word and Excel), and Confidentiality required.
• 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.
• 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.
• Ability to work periodic overtime required; can include weekends.
• 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.

Preferred

• Previous Life insurance experience, claims experience, or relevant job experience.
• Ability to adjust to multiple demands and shifting priorities. Consistently demonstrate the MetLife values. Ability to introduce new ideas to improve work processes.
• College degree (Associates or higher) is desirable.

Number of Openings

3

At MetLife, we are leading the global transformation of an industry we’ve long defined. United in purpose, diverse in perspective, we are dedicated to making a difference in the lives of our customers.

The salary range for applicants for this position is $41,600 to $47,000.

Benefits We Offer

Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!

About MetLife

Recognized on Fortune magazine’s list of the 2024 “World’s Most Admired Companies”, Fortune World’s 25 Best Workplaces™ for 2024, as well as the 2024 Fortune 100 Best Companies to Work For ®, MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies: providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.