18 days old

Sr. LTC Appeals Specialist

Tampa, FL
**Job Location:** Tampa, FL **Alternate Job Location** : Work From Home

**Role Value Proposition:**

Global Operations (Global Ops) focuses on creating positive experiences for MetLife customers and helping the company make the best use of its global resources. Were looking for unique talent with fresh perspectives that can propel innovation. In this role you will handle complex appeals for claimants who have been declined benefit eligibility for LTC either at initial request for benefits or at discharge from a benefit period. May provide coaching to lower level associates

**Key Responsibilities:**

+ Reviews complex LTC claims appeals by completing a fair, independent assessment, thoroughly reviewing the file and determining the benefit denial was appropriate.

+ Evaluates complex plan provisions, and medical and functional information.

+ Identifies questionable aspects to the claim, determines need for additional information and obtains it.

+ Makes decisions based on available information, writes customized, clear, concise letters with appropriate details to insureds, their representatives or attorneys regarding the decision in a timely manner.

+ Ensures compliance with the customer contract and state regulations.

+ Tracks and follows up on litigation issues for the appeal team.

+ Coaches, directs and develops Appeals Specialists and acts as a training resource to raise individual capabilities.

+ Provides feedback to Appeals Specialists as appropriate.

+ Anticipates, resolves, and responds to high level escalated claim/customer issues.

+ Performs other related duties as assigned or required.

**Essential Business Experience and Technical Skills:**


+ 3-5 years of LTC experience

+ Strong written and verbal communication skills

+ Knowledge of medical procedures and terminology.

+ Ability to read, interpret and explain contracts and long term care plans.

+ High School Diploma required


+ Knowledge of writing letters

+ Bachelors Degree

+ Solid business knowledge of Long term care, State laws, and appeal handling



**Business Category**

_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.**


  • Legal

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Sr. LTC Appeals Specialist

Tampa, FL

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Tampa, FL

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