STD Claim Support Specialist

About the role

An expert technical resource to the claim team who supports team members and the STD Unit Leader in ensuring claim management accuracy, customer centricity, and efficiency. Coaches and mentors team members to enhance their knowledge, skills, and effectiveness as claim-management professionals. You will be responsible for coaching and developing staff, ensuring they process claims appropriately and meet the needs of customers and claimants. Acts as support for both the team and the Unit Leader, covering for them in their absence.

Responsibilities

• Partners with the STD Unit Leader to analyze, identify, and implement strategies to enhance claim management, customer centricity, and team efficiency while monitoring strategy effectiveness.
• Drives Claim Management Accuracy and Customer Centricity through the QQA program by auditing claim file reviews, including monthly call monitoring for Claims Specialists to identify improvement opportunities, skillset gaps, trends for quality, service, and/or compliance.
• Fully engages in customer-focused training; models learned behaviors.
• Supports and guides assigned team members to ensure they have the knowledge, skills, tools, and resources to succeed in achieving expectations.
• Ensures the team meets or exceeds regulatory and compliance requirements and performance guarantee commitments.
• Coaches and mentors new hires to enhance their skills, knowledge, and effectiveness as Claim Specialists. Assesses new hire readiness for independent work.
• Reviews and approves key decisions made by team members within authority limits.
• Assesses and provides information, trends, and observed behaviors of assigned team members to the STD Unit Leader. Partners with the STD Unit Leader to enhance team member performance.
• Identifies and facilitates claim discussions on highly complex claims with appropriate resources, including the STD Unit Leader, Clinical Resources, and Vocational Rehabilitation Consultants.
• Supports team members to ensure effective transitioning of claims to LTD (as appropriate).
• Mentors team members to identify and facilitate Return to Work opportunities through their own efforts or by engaging appropriate resources.
• Provides candid and specific feedback to team members to support their growth and development.

Requirements

• A comprehensive understanding of disability contractual provisions, especially the definition of disability.
• Strong communication skills, including the ability to coach Case Specialists to interview claimants dynamically with the goal of setting claimant expectations and obtaining necessary information to administer the claim.
• Basic knowledge of medical conditions, treatments, and prognosis.
• Expertise in systems and tools (e.g., MDG, DPA, Intellis) and how to leverage them to improve claim management effectiveness.
• Strong coaching and mentoring skills.
• Critical-thinking skills.
• Ability to give and receive feedback using specific measurements and observed behaviors.
• Openness to receiving feedback.
• Strategic-thinking skills.
• Prioritization skills and ability to balance quantity and quality.

Qualifications

• Associate Degree (preferred).
• 2+ years of claims management experience, preferably in the healthcare field.
• 5+ years of management experience.
• Proficient in Microsoft Word/Excel.
• Prior STD, state leave, and/or Family Medical Leave Act claims knowledge preferred.
• Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
• Strong problem-solving and analytical skills.
• Ability to work independently.
• Ability to multitask, comfortable working with multiple priorities in a changing environment.

Pay

The expected salary range for this position is $49,100 - $82,800. This role may also be eligible for annual short-term incentive compensation and stock-based long-term incentives. All incentives and benefits are subject to the applicable plan terms.

Benefits

• Comprehensive health plan including medical/prescription drug and vision coverage.
• Dental insurance.
• No-cost short- and long-term disability.
• Company-paid life insurance and legal services.
• Retirement pension funded entirely by MetLife.
• 401(k) with employer matching.
• Group discounts on voluntary insurance products (auto, home, pet, critical illness, hospital indemnity, and accident insurance).
• Employee Assistance Program (EAP) and digital mental health programs.
• Parental leave.
• Paid time off, paid holidays, and volunteer time off.
• Tuition assistance.