[Remote] Claim Examiner - Life

Note: The job is a remote job and is open to candidates in USA. MetLife is one of the world’s leading financial services companies, providing insurance, annuities, and employee benefits. They are seeking a FEGLI Life Claims Specialist responsible for evaluating, adjudicating, and processing life insurance claims, requiring strong analytical skills and excellent customer service.

Responsibilities

• Obtain and verify all missing information required to evaluate FEGLI life insurance claims
• Interpret policy provisions and manually adjudicate claims within a payment authority up to $400,000
• Review claims to determine whether referral to a Complex Case Manager or Claims Quality Specialist is required
• Actively follow up on open claims and ensure timely resolution
• Maintain accuracy and compliance with production and quality standards
• Respond to written inquiries from policyholders, beneficiaries, attorneys, and families
• Provide clear guidance on claim procedures and resolve issues promptly
• Handle outbound calls related to claim servicing and support customer escalations from Customer Service Associates
• Research claim issues submitted through telephone referrals and provide timely responses
• Work closely with administrative staff to clarify plan provisions and resolve claim discrepancies
• Maintain strong rapport with internal and external customers through ownership, professionalism, and service-oriented communication
• Coach new Life Case Manager Specialists on procedures and workflow
• Provide UAT (User Acceptance Testing) support for system enhancements
• Document and update all claim activity using PowerBuilder, Livelink, EDCS, Accurint, Excel, Microsoft Word, and internal tracking systems
• Initiate investigations using internal and external resources (e.g., autopsy reports, toxicology, accident reports, medical records, missing beneficiary searches, homicide investigations)
• Stay current on FEGLI procedures through Livelink and required training

Skills

• Strong analytical ability and sound judgment in evaluating life claim submissions
• Excellent written and verbal communication skills
• Ability to manage multiple deadlines and shifting priorities in a fast-paced environment
• Proficiency in Microsoft Word and Excel; strong data entry accuracy
• Ability to maintain confidentiality and handle sensitive situations professionally
• Demonstrated customer service excellence and problem-solving skills
• College degree or equivalent relevant experience
• Prior life insurance or claims experience highly desirable

Benefits

• Comprehensive health plan that includes medical/prescription drug and vision
• Dental insurance
• No-cost short- and long-term disability
• Company-paid life insurance
• Legal services
• Retirement pension funded entirely by MetLife
• 401(k) with employer matching
• Group discounts on voluntary insurance products including auto and home
• Pet
• Critical illness
• Hospital indemnity
• Accident insurance
• Employee Assistance Program (EAP)
• Digital mental health programs
• Parental leave
• Paid time off
• Paid holidays
• Volunteer time off
• Tuition assistance

Company Overview