Description and Requirements

Basic Function

Responsible for structuring Long-Term Disability (LTD) claims based on claim receipt date. Support the claim adjudication (claim specialist) team with the initial claim setup in accordance with the plan provisions, identify potential recurrent claims, and utilize several systems to verify coverage. Determine LTD eligibility. Prepare and send acknowledgment in 5-days to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD - stand-alone claims, bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, claim support specialist (QA), Claims Manager (stateside supervisors), EE, ER through emails/systems.

Essential Functions

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)

• Analyze and research all discrepancies.

• Research & Investigate and resolve outstanding items

• Determine eligibility and applicable plan provisions while meeting timeliness goals

• Clear and accurate written and verbal communication (Scripted and Templatized) with employee, employer & stateside resources by email

• Establish action plans for each file to bring claims to resolution

• Utilize internal and external specialty resources to maximize impact on each claim file

• Utilize Intellis and ACS (SIR) to update and maintain accurate data record

• Use PC programs to increase productivity and performance

• Ensure that the assigned targets are met in accordance with SLA and Internal standards

• Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence

• Work as a team member to meet office goals to obtain disability's vision while demonstrating core values and meeting key measures.

• Ensure adherence to established attendance schedules

• Sedentary work - involves sitting most of the time

• Close visual acuity - viewing a computer terminal and extensive reading

• Talking - expressing or exchanging ideas by means of the spoken word.

• AI Fluency - Working knowledge of Microsoft Copilot.

Any other essential function that may occur from time to time as directed by the Supervisor.

Primary Internal Interactions

• AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.

• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.

• Subject Matter Expert for the purpose of work thread related issues and escalated transactions.

• QCA for the purpose of feedback and audit.

• Trainers for the purpose of Pre-process and Process training.

Primary External Interactions

• Employees (EE), Employers (ER), Claims specialist & other Stateside Teams on emails

• SME / Trainers at the client end for training.

Organizational Relationships

Reports To: Assistant Manager, Long Term Disability Process Supervises: 0

Skills

Technical Skills

• Good computer navigation skills

• Good keyboarding speed

• Good knowledge of complete MS Office suite

Process Specific Skills

• Knowledge about the Insurance industry in US

• Knowledge about US Culture

• Knowledge of Insurance principles

Soft skills (Minimum)

• Communication skills - should be able to read, interpret business documents. Good oral/written communication

• Proficiency in English - Spoken and Written

• Analytical and interpersonal skills

• Escalate issues if required

• Data gathering ability/ Eye for detail

• Team work/ Managing Self / Adaptability

• Ability to work successfully in production driven environment

• Adaptability to change

• Ability to work on routine/standardized transactions

Soft Skills (Desired)

• Self disciplined and result oriented

• Ability to multi task

• Ability to work effectively as part of a team

• Knowledge of Medical Terminology (preferred but not compulsory)

About MetLife

Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™, 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.

As part of our New Frontier strategy, MetLife is building an AI-enabled, people-centered future. We're looking for people who bring curiosity, adaptability, and a growth mindset as we use AI to enhance how we serve customers, support communities, and evolve the way work gets done. At MetLife, AI is a responsible partner that supports human judgment, creativity, and continuous improvement while helping us build trust, inclusion, and long-term value.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!