Team Leader - Operations

Job Description

Requirements

Description and Requirements

• Administer ADA (Americans with Disability Act) standalone claims
• Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems.
• Promptly review new ADA, 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 physicians 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 disabilitys 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.

• UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
• Subject Matter Expert for the purpose of work thread related issues and escalated transactions
• QCA for the purpose of feedback and internal Performance Guarantee quality audit team
• Trainers for the purpose of Pre-process and Process DCA training
• Disability Customer Advocates for escalation resolution

• End customer to be contacted through emails/calls for information gathering/decision update
• Claims specialist & other Stateside Teams on emails/calls
• SME / Trainers at the client end for training

About MetLife

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 empathy, were inspired to transform the next century in financial services.

At MetLife, its #AllTogetherPossible . Join us!