Senior LTD Claims Lead: Complex Case Expert

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

Benefits offered by this job

Health insurance

Life insurance

401(k) with employer matching

PTO and holidays

Parental leave

Job summary

MetLife’s Global Customer Service and Operations team seeks a Lead LTD Claims Specialist to independently manage the most complex long-term disability claims in the United States. You will document decisions by integrating medical, occupational, and financial data and partner with physicians, attorneys, and CPAs to ensure defensible outcomes.

You will mentor peers and drive continuous improvement in claim quality.

Qualifications

• 5+ years LTD/IDI claims experience.
• Demonstrated customer service skills through internal and external interactions.
• Ability to apply independent judgment and make well-reasoned decisions.
• Strong problem-solving and critical-thinking skills.
• Proficiency working across multiple systems and technology resources.
• Strong organizational and time-management skills.

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

LTD/IDI claims experience

Customer service

Independent judgment

Problem-solving

Multi-system proficiency

Time management

Education

Bachelor's degree

Job description

MetLife’s Global Customer Service and Operations team seeks a Lead LTD Claims Specialist to independently manage the most complex long-term disability claims in the United States. You will document decisions by integrating medical, occupational, and financial data and partner with physicians, attorneys, and CPAs to ensure defensible outcomes.

You will mentor peers and drive continuous improvement in claim quality.