Location: Must live within a commutable distance of the Tampa FL Office only
In office once a month for in office meetings
12 weeks In Person Training
Key Responsibilities:
· Manages assigned caseload of initial eligibility files with limited supervision.
· Utilizes critical thinking and independent judgment and analysis to provide timely, balanced, and accurate claims decisions in a time sensitive, compliance driven and fast paced environment.
· Compiles file documentation requiring extensive policy and factual detail.
· Identifies information and resources needed to make initial benefit eligibility determinations, to include review of detailed medical information and other documentation necessary for rendering initial eligibility decision.
· Communicates decisions to policyholders and or their representatives in both verbal and written form.
· Composes highly detailed letters to policyholders and or their representatives outlining status of review and basis of determination.
· Clarifies and reconciles inconsistencies.
· Conducts in depth detailed information-gathering phone calls that obtain medical condition details and other information.
· Engages with various medical and legal resources in situations where warranted.
· Represents MetLife at deposition and trial due to first party litigation environment.
Essential Business Experience and Technical Skills:
Required
· Strong communication skills, both written and oral
· Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning
· Experience using MS office products
· Strong organizational skills.
· High School Diploma/GED and 3-5 years related experience
Preferred
· Bachelor’s Degree
· 2-4 years professional experience