The Unit Manager provides medical consulting for claims assessments, conducts research on medical records, and creates return-to-work plans while collaborating with various stakeholders to support claim processes.
Description and Requirements
Job Responsibiliti es
* Provides professional medical, technical, consulting advice, and recommendation s 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 recommendation s 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).
Technical Skills/other skills
* Computer navigation skills
* Excellent Keyboarding and data entry speed
* Knowledge about US Culture is preferred.
* Excellent verbal/written communication skills - should be able to read, interpret business documents.
* Excellent analytical and interpersonal skills
* Data gathering ability/ Eye for detail.
* Ability to comprehend and apply varied rules to multiple policies.
* Teamwork/ Managing Self / Adaptability
* Ability to work successfully and perform detail-oriente d work in production driven environment.
* Excellent organizational skills
* Proven ability to meet quality and time standards.
* Ability to work on routine/standa rdized transactions.
* Possess strong knowledge of medical conditions, symptoms, and terminology.
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™, 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 our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
#BI-Hybrid
Job Responsibiliti es
* Provides professional medical, technical, consulting advice, and recommendation s 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 recommendation s 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).
Technical Skills/other skills
* Computer navigation skills
* Excellent Keyboarding and data entry speed
* Knowledge about US Culture is preferred.
* Excellent verbal/written communication skills - should be able to read, interpret business documents.
* Excellent analytical and interpersonal skills
* Data gathering ability/ Eye for detail.
* Ability to comprehend and apply varied rules to multiple policies.
* Teamwork/ Managing Self / Adaptability
* Ability to work successfully and perform detail-oriente d work in production driven environment.
* Excellent organizational skills
* Proven ability to meet quality and time standards.
* Ability to work on routine/standa rdized transactions.
* Possess strong knowledge of medical conditions, symptoms, and terminology.
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™, 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 our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
#BI-Hybrid
Top Skills
Computer Navigation Skills
Data Entry Skills
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