Specialist

MetLife

Required skills

Website: metlife.com
Job details:

Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures
Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee or employer through outgoing calls, email or other supporting systems.
Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision.
Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc .
Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
The position is expected to do absence management and adjudication on Federal, State and company leaves.
Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician’s office

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 , entitlement and applicable plan provisions while meeting timeliness goals
Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
Establish action plans for each file to bring claims to resolution
Utilize internal and external specialty resources to maximize impact on each claim file
Use PC programs to increase productivity and performance
Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee 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

Any other essential function that may occur from time to time as directed by the Supervisor. Click on Apply to know more.

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