Senior Long Term Care Appeals Specialist

Location: VirtualRole Value Proposition:Reviews Long Term Care Appeals by completing an independent assessment and conducting a thorough and holistic evaluation of the claim file and adverse determination made on the LTC claim. Reviews accuracy of the original determination by evaluating plan/policy provisions and medical information, gathering additional information and engaging the right resources, as appropriate. Directs the course of investigation to ensure completion of a full and fair appeal review.Key Responsibilities:* Ability to successfully manage caseload with limited supervision, discretion, professionalism and empathy while exercising independent judgment.* Provides timely, balanced and accurate appeal reviews in a time-sensitive, highly customer involved and fast-paced environment.* Compiles file documentation requiring extensive LTC policy/plan knowledge and factual detail.* Conducts in-depth, detailed information-gathering phone calls as appropriate for the appeal under review while ensuring clear understanding of contractual requirements of policy/plan and clarifying and reconciling inconsistencies.* Identifies information and resources needed to make accurate, thorough appeal determinations regarding benefit eligibility and plan/policy provisions; coordinates use of resources as appropriate.* Communications (written and verbal) with policyholders and/or their authorized representative, inclusive of but not limited to plan/policy provision details and appeal decisions.* Partners with Manager to identify training needs, implement process improvements, elevate individual and organizational capabilities.* Partners with Manager to resolve escalations.* Embraces and promotes change initiatives within LTC and the Appeals Team.Essential Business Experience and Technical Skills:Required:* 3+ years of claims experience* Thorough knowledge of LTC product along with non-ERISA and state specifics for LTC* Strong technical and communication skills (written and verbal)* Demonstrate critical thinking in activities requiring analysis, investigation and/or planning* Strong problem solving, organizational and analytical skills* Ability to work independently* Ability to manage multiple priorities in a changing environment* Ability to prioritize and maintain qualityPreferred:* Bachelor''s degree or equivalent business experience* 5+ years Long Term Care experienceBusiness CategoryFinancial Management Group_12713Travel0%Number of Openings1At MetLife, we''re leading the global transformation of an industry we''ve long defined. United in purpose, diverse in perspective, we''re dedicated to making a difference in the lives of our customers.MetLife: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 help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.We are one of the largest institutional investors in the U.S. with $642.4 billion of total assets under management as of March 31, 2021. We are ranked 46 on the Fortune 500 list for 2021. In 2020, we were named to the Dow Jones Sustainability Index (DJSI) for the fifth year in a row. DJSI is a global index to track the leading sustainability-driven companies. We are proud to have been named to Fortune magazine''s 2021 list of the ''World''s Most Admired Companies.''MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.The wage range for applicants for this position is $54,200 - $91,300. This role is also eligible for annual short-term incentive compensation. MetLife offers a comprehensive benefits program, including healthcare benefits, life insurance, retirement benefits, parental leave, legal plan services and paid time off. All incentives and benefits are subject to the applicable plan terms.We want to make it simple for all interested and qualified candidates to apply for employment opportunities with MetLife. For further information about how to request a reasonable accommodation, please click on the Disability Accommodations link below.MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.MetLife maintains a drug-free workplace.

Created: 2026-05-02