AI-Driven LTD Claims Leader

MetLife; United States; On-site; USD 64,000 - 80,000; Full time

Benefits offered by this job

Annual incentive

Job summary

MetLife’s Global Customer Service and Operations (GCSO) team is seeking a Lead LTD Claims Specialist to independently manage the most complex long-term disability claims in the United States, ensuring accurate, compliant, and well-documented determinations.

You will mentor peers, influence claim outcomes, collaborate with physicians, attorneys, CPAs, and other partners, and contribute to continuous improvement while providing timely updates to claimants and stakeholders.

Qualifications

• 5+ years LTD/IDI insurance claims experience.
• Experience applying independent judgment and making well-reasoned decisions based on available facts.
• Experience utilizing AI in a professional environment.
• Bachelor’s degree; knowledge of STD/FMLA, state leave laws, workers’ compensation, ERISA.

Responsibilities

• Lead the management of the most complex long‑term disability (LTD) claims by exercising independent judgment to ensure accurate, timely, and compliant claim decisions.
• Create thorough claim documentation and correspondence by analyzing medical, occupational, financial, and policy information to support well‑documented determinations.
• Oversee claim evaluations by identifying and reconciling inconsistencies, leveraging Fraud, Waste and Abuse resources, and resolving escalated customer concerns while referring matters to appeals, complaints, or litigation support as needed.
• Manage communication with claimants, customers, providers, attorneys, brokers, and family members by delivering clear, timely updates on claim status, determinations, and complex benefit calculations.
• Develop associate capability and claim quality by supporting onboarding, coaching, mentoring, and participating in projects that drive continuous improvement and enhance customer experience.
• Coordinate with internal and external partners, including physicians, attorneys, vocational consultants, and CPAs, to obtain and evaluate information required for thorough and defensible claim decisions.

Skills

Customer service

Independent judgment

Problem solving

Time management

Communication

AI experience

Education

Bachelor’s degree; STD/FMLA/ERISA knowledge

Tools

Multiple systems

Job description

MetLife’s Global Customer Service and Operations (GCSO) team is seeking a Lead LTD Claims Specialist to independently manage the most complex long-term disability claims in the United States, ensuring accurate, compliant, and well-documented determinations.

You will mentor peers, influence claim outcomes, collaborate with physicians, attorneys, CPAs, and other partners, and contribute to continuous improvement while providing timely updates to claimants and stakeholders.