Claims Analyst

MetLife Legal Plans is currently looking for a Claims Analyst to join our growing Claims team.

This individual will report directly into our Claims Supervisor.

We strongly prefer individuals who have an Active Adjusters License for multiple states within the United States.

This position is fully remote. The ideal candidate may be located anywhere in the continental United States.

A Day in the Life of a Claims Analyst at MetLife Legal Plans:

The Claims Analysts review incoming out-of-network fee reimbursement claims from our legal plan members for all aspects of accuracy. They will make determinations resulting from these reviews and will prepare these claims for payment or will forward the claims to in-house counsel for further analysis and determination. This position includes internal/external communications between our in-house counsel and our MetLife Legal Plans members. Claims Analyst Review billings received from our Panel Attorneys for services provided to our legal plan members. These reviews include analyzing a billing for correct coding, appropriate fees, and specific required information. The Claims Analyst will make the necessary corrections to these billings and continue with the billing payment process or decide if additional review and determination from our in-house counsel is required.

Essential Duties and Responsibilities:

Claims Analyst – Billing:

• Obtain Adjusters licenses as required to meet business need

• Complete continuing education to maintain licenses

• Performs an analysis of Attorney’s claims and determines necessary adjustments 
• Works closely with the Accounting department to recover Panel Attorney overpayments 
• Places Attorney Claims on hold when further payment decisions or backup are required 
• Determines appropriate claims notation for payment and audit purposes
• Reviews Claims based on Analyst authority level and process reviewed claims received from in house counsel
• Send billing inquiry memos to attorneys when more details are necessary or when payments are unable to be made
• Processes reconciliation “close”, resolving audit discrepancies before forwarding billings to the Accounting department for final approval that release claims for payment
• Other duties as assigned.

  Claims Analyst – Reimbursements:

• Complete analysis of Fee Reimbursement Claims including checking eligibility, determining member specific coverage, and verifying all required documentation included to approve payment

• Responsible for ensuring all levels of member information is secure during processing 
• Determines when a claim needs to have further approval and is responsible for communicating the need to the appropriate individuals.
• Responsible for keeping all communication avenues up to date with claims information and status. 

• Supports and processes the Fee Reimbursement reconciliation close using MetLife Legal Plans systems, forwarding claims to be paid to Accounting for final approval and release cl for payment
• Communicate with our legal plan members with answers to their questions and status of their reimbursements via email and phone

• Communicate with internal teams to assist with complex Fee Reimbursement claims 
• Submits documentation for appeals and check reissues
• Other duties as assigned.

Minimum Qualifications (Knowledge, skills, and abilities required):

• Active Claims Adjuster License
• Ability to multitask and work with a sense of urgency while maintaining attention to detail
• Ability to meet and deliver on Service Level deadlines
• Detail-oriented and well-organized, with the ability to effectively manage a high-volume workload and prioritize
• Self-motivated with the ability to take initiative and work independently as well as with a team
• Ability to communicate effectively and professionally with our legal plan members and internally with other company associates
• Proficiency with Outlook and Microsoft Office products including Excel and Microsoft Word 

What Will Make You Special (Preferred knowledge, skills, and abilities):

• Active Claims Adjuster License for multiple states 
• 3+ years of experience in claims processing 
• Bachelor’s degree from an accredited university or equivalent work experience 
• Knowledge of claims and legal industry 
• Strong attention to detail and excellent organizational skills
• Ability to work within a team environment

• Efficiently manage various competing priorities to ensure timely payment, follow-up and claim resolution

Characteristics of our Claims Analysts (Competencies):

• Problem solving/analytical skills
• Time management skills
• Detail-oriented
• Deadline awareness
• Communication proficiency
• Ability to thrive in a teamwork environment

No Travel Required for this position.

Who We Are:

MetLife Legal Plans is the country's largest provider of legal voluntary benefits. We have more than 40 years of experience in employee legal services and are committed to providing excellent care to our plan members, sponsors and 18,000+ attorneys.

We are trusted by nearly 7 million families and more than 200 Fortune 500 companies who offer our service as an employee benefit.

It’s an exciting time to join our team. We are growing quickly and have a bold vision for our future as we evolve our company to dream bigger, move faster, and use creativity and technology to build products people love.

MLP's Core 4:

• Put customers first
• Be the Best
• Make things easier
• Succeed together

Anticipated application close date is 9/28.This job was posted on 9/3 and is expected to close within 25 days from the posting date. 

Benefits snapshot. 

• Two Healthcare Insurance options (Traditional PPO or HSA with employer contribution)
• Dental and Vision Insurance
• 401(k) plan with company contribution and free access to financial advisors
• Generous Paid Time Off (PTO) program with 23-39 days annually based on years of service, plus prorated PTO for new hires*
• Free Aura® Identity Theft & Fraud Protection
• Free access to the MetLife Legal Plans benefit
• Company-paid Short- and Long-Term Disability
• Corporate discounts
• Market-competitive salaries with annual bonus eligibility
• Nine company-paid holidays
• Paid parental leave
• Parking or RTA subsidy for Cleveland employees
• Pet Insurance
• Tuition Reimbursement Program
• Voluntary Accident and Critical Illness Insurance
• Volunteer Day
• Robust Employee Assistance Program (EAP)
• Financial wellness tools, education, and coaching

*PTO is prorated during an employee's first year of employment based on their hire date. Employees hired in the first quarter of the year receive 18 days of PTO, those hired in the second quarter receive 16 days, employees hired in the third quarter receive 9 days, and those hired in the fourth quarter receive 7 days. PTO is awarded at the time of hire and then moves to the standard annual accrual schedule beginning January 1 of the following year

Note: This job description in no way states or implies that these are the only duties to be performed by the associate in this position. Associates will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbent will possess the skills, aptitude and ability to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at-will” relationship.

MetLife Legal Plans is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law (“protected characteristics”).

If you need an accommodation due to a disability, please email us at View email address on click.appcast.io. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.