Senior LTD Claims Leader & Complex Case Expert

MetLif; United States; Remote; USD 48,000 - 80,000; Full time

Benefits offered by this job

Annual incentive

Comprehensive benefits

401(k) with employer matching

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 guide claim decisions, document thoroughly, and resolve issues with cross-functional collaboration.

You will mentor peers, drive continuous improvement, and influence claim quality while partnering with medical, legal, and financial experts to ensure defensible outcomes.

Qualifications

• 5+ years of LTD/IDI insurance claims experience.
• Demonstrated customer service skills through internal and external interactions.
• Experience applying independent judgment and making well-reasoned decisions based on available facts.
• Strong problem-solving and critical-thinking skills with strong organizational and time-management skills.
• Proficiency working across multiple systems and technology resources in a fast-paced environment.
• Experience utilizing AI in a professional environment.

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

AI in professional environment

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 guide claim decisions, document thoroughly, and resolve issues with cross-functional collaboration.

You will mentor peers, drive continuous improvement, and influence claim quality while partnering with medical, legal, and financial experts to ensure defensible outcomes.