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Description and Requirements
• 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 plans. • 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
Education, Technical Skills & Other Critical Requirement
Education Bachelor's degree (Medical) or diploma with a minimum of 15 years of education.
Experience
(In Years) Required • Current RN licensure • 4+ years of experience as an RN with Clinical/Ops Experience Preferred • 7+ years Disability claims and/or clinical experience. • Disability claims experience • Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
About MetLife
Recognized on Fortune magazine's list of the 2025 "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™ for 2024, MetLife , through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. 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, we're inspired to transform the next century in financial services.
At MetLife, it's #AllTogetherPossible . Join us!
#BI-Hybrid
• 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 plans. • 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
Education, Technical Skills & Other Critical Requirement
Education Bachelor's degree (Medical) or diploma with a minimum of 15 years of education.
Experience
(In Years) Required • Current RN licensure • 4+ years of experience as an RN with Clinical/Ops Experience Preferred • 7+ years Disability claims and/or clinical experience. • Disability claims experience • Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
About MetLife
Recognized on Fortune magazine's list of the 2025 "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™ for 2024, MetLife , through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. 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, we're inspired to transform the next century in financial services.
At MetLife, it's #AllTogetherPossible . Join us!
#BI-Hybrid
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