Specialist

Requirements

Description and Requirements

Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures

•   Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee or employer through outgoing calls, email or other supporting systems.
•   Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision.
•   Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc .
•   Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
•   Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
•   The position is expected to do absence management and adjudication on Federal, State and company leaves.
•   Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician’s office
  
  
  

Essential Functions:

•   Analyze, validate and process transactions as per Desktop procedures (L3 & L4 )
•   Analyze and research all discrepancies
•   Research & Investigate and resolve outstanding items
•   Determine eligibility , entitlement and applicable plan provisions while meeting timeliness goals
•   Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
•   Establish action plans for each file to bring claims to resolution
•   Utilize internal and external specialty resources to maximize impact on each claim file
•   Use PC programs to increase productivity and performance
•   Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
•   Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
•   Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and
  
  
  

meeting key measures

•   Ensure adherence to established attendance schedules
•   Close visual activity - viewing a computer terminal and extensive reading
  
  
  

Any other essential function that may occur from time to time as directed by the Supervisor.

About MetLife

Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World’s 25 Best Workplaces™, 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.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we’re inspired to transform the next century in financial services. At MetLife, it’s #AllTogetherPossible . Join us!

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