PT IDI Claims Specialist

Hays; Orlando (FL); On-site; USD 55,000 - 75,000; Part time

Job summary

A leading company seeks a PT IDI Claims Specialist to manage insurance claims. This role entails evaluating individual disability income insurance claims, ensuring compliance with regulations, and providing exemplary customer service. Candidates should have 3+ years of relevant experience and strong critical thinking skills to handle complex situations effectively.

Benefits

Medical benefits

Dental benefits

Vision benefits

401K

Life Insurance

Qualifications

• 3+ years of IDI or LTD insurance claims experience required.
• Ability to manage multiple systems and technology sources.
• Excellent customer service skills.

Responsibilities

• Independently manage an assigned caseload and make claims decisions.
• Provide timely claims reviews, documentation, and determinations.
• Collaborate with external and internal resources for claims evaluations.

Skills

Critical thinking

Problem-solving

Communication skills

Organizational skills

Education

Bachelor’s degree

Job description

The final salary or hourly wage, as applicable, paid to each candidate/applicant for this position is ultimately dependent on a variety of factors, including, but not limited to, the candidate’s/applicant’s qualifications, skills, and level of experience as well as the geographical location of the position.

Applicants must be legally authorized to work in the United States. Sponsorship not available.

Our client is seeking a PT IDI Claims Specialist in Tampa, FL

Role Description

Role Value Proposition:
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Claims Consultant evaluates individual disability income insurance claims and makes claims decisions in accordance with policy provisions and within prescribed time service standards. In this role, the Claims Consultant is responsible for exercising independent judgment, demonstrating critical thinking skills, exemplary customer service as well as effective inventory management skills

Key Responsibilities:
· Independently manages an assigned caseload of, and makes claims decisions on, moderately complex claims which consists of pending, ongoing, disputed and appeal reviews.
· Provides timely, balanced, and accurate claims reviews, documentation, and decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.
· Provides timely and detailed written communication throughout the claim evaluation outlining comprehensive claim status and/or claim determinations.
· Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations.
· Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members throughout the claim evaluation.
· Compiles file documentation and correspondence requiring extensive policy analysis and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available.
· Collaborates with both external and internal resources, such as physicians, attorneys, vocational consultants, and CPAs to gather data such as medical/occupational information to ensure claim decisions are well-reasoned and thorough.
· Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources, as needed.
· Identifies offsets and proficiently calculates monthly benefits, to include COLA, Social Security Offsets, Residual Disability, and other non-routine payments.
· Provides timely and detailed written communication during the claim evaluation, which outlines and supports the status of the evaluation and/or claim determination.
· Addresses and resolves escalated customer complaints in a timely and thorough manner, including drafting written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to litigation support partners.
· May represent MetLife at depositions and trials.

Skills & Requirements

Essential Business Experience and Technical Skills:

Required Skills and Experience:
· 3+ years of IDI or LTD insurance claims experience - IDI experience is the priority.
· Ability to effectively manage multiple systems and technology sources.
· Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.

Required:
· Prior experience with independent judgement and decision making.
· Critical thinking and analysis skills when reviewing information.
· Creative problem-solving abilities when working in grey areas and the ability to think outside the box.
· Excellent interpersonal and communication skills in both verbal and written form.
· Excellent customer service skills proven through internal and external customer interactions.
· Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
· Organizational and time management skills.
· Ability to effectively manage multiple systems and technology sources.
· 3+ years of IDI or LTD insurance claims experience.

Preferred:
· Bachelor’s degree
· 5+ years IDI experience

Benefits/Other Compensation

This position is a contract/temporary role where Hays offers you the opportunity to enroll in full medical benefits, dental benefits, vision benefits, 401K and Life Insurance ($20,000 benefit).

Why Hays?

You will be working with a professional recruiter who has intimate knowledge of the industry and market trends. Your Hays recruiter will lead you through a thorough screening process in order to understand your skills, experience, needs, and drivers. You will also get support on resume writing, interview tips, and career planning, so when there’s a position you really want, you’re fully prepared to get it.

Nervous about an upcoming interview? Unsure how to write a new resume?

Visit the Hays Career Advice section to learn top tips to help you stand out from the crowd when job hunting.

Hays is committed to building a thriving culture of diversity that embraces people with different backgrounds, perspectives, and experiences. We believe that the more inclusive we are, the better we serve our candidates, clients, and employees. We are an equal employment opportunity employer, and we comply with all applicable laws prohibiting discrimination based on race, color, creed, sex (including pregnancy, sexual orientation, or gender identity), age, national origin or ancestry, physical or mental disability, veteran status, marital status, genetic information, HIV-positive status, as well as any other characteristic protected by federal, state, or local law. One of Hays’ guiding principles is ‘do the right thing’.
We also believe that actions speak louder than words.
In that regard, we train our staff on ensuring inclusivity throughout the entire recruitment process and counsel our clients on these principles. If you have any questions about Hays or any of our processes, please contact us.

In accordance with applicable federal, state, and local law protecting qualified individuals with known disabilities, Hays will attempt to reasonably accommodate those individuals unless doing so would create an undue hardship on the company. Any qualified applicant or consultant with a disability who requires an accommodation in order to perform the essential functions of the job should call or text 813.336.5570.

Drug testing may be required; please contact a recruiter for more information.

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#1176249 - Brianna Lucarini