Clinical Support Consultant Claims- RN

MetLife; United States; On-site; USD 70,000 - 80,000; Full time

Benefits offered by this job

Comprehensive health plan

Dental insurance

401(k) with employer matching

Tuition assistance

Employee Assistance Program (EAP)

Parental leave

Volunteer time off

Company-paid life insurance

Job summary

An established industry player is seeking a Clinical STD/FMLA Claims Specialist to join their dynamic team. In this role, you will provide exceptional customer service while processing Short Term Disability claims and managing concurrent Family and Medical Leave Act claims. You will utilize your clinical expertise to assess claims, communicate effectively with claimants and healthcare professionals, and develop return-to-work plans. The company offers a supportive environment with comprehensive benefits, emphasizing holistic well-being and professional growth. If you're passionate about making a difference in the lives of others, this opportunity is perfect for you.

Qualifications

• 2+ years of clinical experience required with strong communication skills.
• Critical thinking skills for analysis and planning are essential.

Responsibilities

• Assess and analyze claims, ensuring timely and accurate processing.
• Communicate with various stakeholders to gather necessary information.

Skills

Clinical Experience

Communication Skills

Critical Thinking

Education

Nursing Degree with RN License

BSN Preferred

Job description

Posting Region/States: United States

Working Schedule: Full-Time

Commutable Distance Required: Yes

Relocation Assistance Available: No

Posted Date: 11-Mar-2025

Job ID: 7043

Description and Requirements

Global Technology & Operations (GTO) includes over 17,000 associates across 42 countries. This role of the Clinical STD/FMLA Claims Specialist will provide exemplary customer service by processing Short Term Disability claims in a timely and accurate manner as well as managing FML claims that will run concurrent with the STD claims for a Large Customer.

Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT, Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR office. Once a month in office for meetings.

Key Responsibilities:

• Independently assess, analyze and render appropriate claim decisions pursuant to certificates on all claims.
• Compare duration control guidelines and clarify functional inconsistencies.
• Develop goal-focused return-to-work plans and/or barriers for return-to-work. Partner with Return-to-Work Coordinator on account to ensure successful RTW.
• Clarify functional capacity through independent problem-solving measures and discretion sufficient to determine initial and ongoing liability by adhering to federal and state law to maintain appropriate and timely claim outcomes.
• Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment.
• Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel.
• Prepare written summary for Quarterly customer meetings to review cases that are identified via report parameters, you or the customer to discuss and participate in quarterly meetings with the Vocational resource and Account team member.
• Participate in claim review meetings as requested by the customer.
• Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as Psychiatric Clinical Specialist, Medical Director or other clinical staff to obtain additional information on a claim by articulating and documenting their rationale for claim direction.
• As the sole owner of the claim, determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim and provide mentoring and/or coaching to less experienced team members. Performs other duties as assigned or required.
• Manages assigned caseload of short-term disability (STD) and/or Family & Medical Leave Act (FMLA) claims; applies specialized clinical training/knowledge to the assessment of cases.

Essential Business Experience and Technical Skills:

Required:

• 2+ years of Clinical Experience required
• Nursing Degree with RN license required
• Strong communication skills, both written and oral.
• Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.

Preferred:

• BSN Preferred
• Disability Claims Experience

Travel:

• Less than 10% (travel to customer sites for business meetings 1 x per year)

The salary range for applicants for this position is $70,000 - $80,000.

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.

MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law (“protected characteristics”).

If you need an accommodation due to a disability, please email us at [e-mail]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.

MetLife maintains a drug-free workplace.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.