Posted: Wednesday, September 6, 2017 1:38 PM
Job Location: United States : Florida : Tampa
Role Value Proposition:
This function develops, maintains, motivates, and manages the activities of Long Term Care (LTC) Claims Care Coordinators to ensure the highest level of service to customers and risk management according to State Compliance and regulatory requirements.
:Manages all aspects of the claims operation for Long:Term Care (LTC) insurance business.
:Reviews claims to ensure compliance with legislative guidelines/established standards and time service standards.
:Handles any escalated customer claims:related appeals and complaints in an effective and timely manner, serving as an expert resource for team members and for senior management.
:Leads, develops and manages a team of associates responsible for evaluating long:term care claims and ongoing benefit eligibility determinations.
:Develop, implement and document all processes and procedures related to claims.
:Utilizes existing management reports for tracking such things as productivity, accuracy and costs and monitors these factors continually, both for individual associates and for the team as a whole. Working with the Director of reporting, recommends alternative reports to improve our ability to monitor progress.
:Provides frequent updates to senior management regarding progress toward goals.
:Partners with external vendors, overseeing activities to guarantee that service:level agreements are met.
:Monitors industry developments and communicates trends to staff.
:Ensures that all performance expectations, internal and external audit standards and regulatory requirements are met, including compliance with HIPAA privacy laws.
:Recommends and implements process improvements to achieve cost savings, service upgrades and/or fraud prevention, updating documentation as required.
:Partners with IT on all claims:related systems issues.
:Demonstrates knowledge of legal issues and has understanding of the litigation process.
:Interacts effectively with individuals at various levels and departments to achieve effective outcomes.
:Ability to partner with Independent Medical Doctors for complex cases.
:Full people management responsibilities, including hiring, firing, promotions, performance and compensation management, and training and development.
:Performs other related duties as assigned or required.
Essential Business Experience and Technical Skills:
:Possess an extensive understanding of medical and contract/plan terminology and policy provisions.
:Solid ability to communicate effectively to a wide range of people; claimants, employers, claim staff, legal, medical, both written and oral.
:Strong analytical and organizational skills in addition to strong verbal and written communication skills. Ability to persuade, interview, empathize, document findings for use by others and format questions.
:Demonstrated superior problem solving and analytical skills.
:Ability to work independently.
:Comfortable working with multiple priorities in a changing environment. Ability to prioritize, balance time and maintain quality.
:Able to Focus on Customers and Produce Results.
:5:7 yrs. relevant business experience
:5+ yrs. insurance claims experience
:3+ yrs. people management experience
:Bachelors degree or equivalent business experience preferred
Global Technology and Operations
Number of Openings
At MetLife, were leading the global transformation of an industry weve long defined. United in purpose, diverse in perspective, were dedicated to making a difference in the lives of our customers.
MetLife is a proud equal opportunity/affirmative action employer committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. It is MetLifes policy to ensure equal employment opportunity without discrimination
• Location: Tampa
• Post ID: 40777787 tampa