Locations: Cary, NC, Oriskany, NY or Tampa, FL-primarily virtual role, with in-person training & collaboration days. Must be within a commutable distance of the Cary, NC, Oriskany, NY Or Tampa, FL office location. Key Responsibilities:
Provides professional medical, technical, consulting advice, and recommendations in support of claims evaluation, investigation and assessment for various claims-related departments, while managing assigned caseload of complex case applying specialized training and knowledge to the assessment of cases and acting as a resource on clinical and technical issues.
Conducts complex research, review and analysis of medical records, treatment plans and claim information.
Provides recommendations regarding claimants’ current potential functional abilities and develops goal-focused return-to-work plan.
Assess training needs and creates, authors and presents medical training to claim and business partner associates.
Engages claimants, healthcare providers, employers and customers to ensure strict adherence in determining functional abilities.
Engages claimants, health care providers and employers in return to work potential and planning while coaching claim specialists on identifying and acting upon return to work potential.
Creates effective requests for medical information which focus on clarifying medical restrictions and limitations and their impact on work functionality.
Performs other related duties as assigned or required
Essential Business Experience and Technical Skills: Required
Moderate knowledge of computer systems.
Strong written/verbal communication.
Current RN licensure
4+ years of experience as an RN
Preferred
BSN
7+ years Disability claims and/or clinical experience.
Disability claims experience
Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
Possess strong knowledge of medical conditions, symptoms, and terminology.
Equal Employment Opportunity/Disability/VeteransIf you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.MetLife maintains a drug-free workplace.