LTC Claims - Reimbursement Coordinator - 21596

Description and Requirements
The Team You Will Join
On MetLife's Global Customer Service and Operations (GCSO) team, customer care is built on trust, empathy, and a commitment to continuous improvement. Whether guiding customers through life's important moments, solving challenges, or simplifying processes with innovative technology, you'll help deliver a differentiated experience grounded in operational excellence. Backed by a collaborative team, you'll play a vital role in strengthening the way we care and advocate for millions worldwide. Here, making a real difference isn't just a goal - it's what we do, one conversation at a time.
The Opportunity
The Reimbursement Coordinator is responsible for analyzing and processing Long Term Care reimbursement claims while ensuring accuracy, timeliness, and completeness across multiple groups with varying benefit provisions. This role applies detailed policy interpretation, evaluates supporting documentation, calculates claim payments and overpayments, identifies potential Fraud, Waste, and Abuse (FWA) indicators, and collaborates with internal partners to deliver a seamless claims experience for insureds and providers. This is a virtual role that primarily works from a home office with a required monthly visit to the assigned GCSO office.
Key Responsibilities

• Analyze and process Long Term Care reimbursement claims accurately and efficiently using the TLC claims system.
• Interpret policy provisions and calculate claim payments and overpayments in accordance with plan guidelines and reimbursement requirements.
• Review claims for completeness, obtain missing documentation, and communicate with providers to gather additional information as needed.
• Identify, document, and escalate potential Fraud, Waste, and Abuse (FWA) indicators in accordance with established procedures and compliance requirements.
• Collaborate with Claim Support Specialists, Customer Call Center representatives, Plan of Care teams, and Benefit Eligibility Coordinators to support a seamless customer experience while meeting quality, accuracy, productivity, and timeliness standards

Required Qualifications

• High school diploma or equivalent
• 1-year relevant claims processing, insurance, healthcare, financial services, or related experience.
• Strong analytical, mathematical, and problem-solving skills with the ability to interpret and apply complex policy provisions.
• Excellent attention to detail, organizational skills, and ability to meet quality and performance standards in a production environment.
• Proficiency with Microsoft Word, Microsoft Excel, and computer-based claims processing systems.
• Demonstrated AI fluency, including the ability to effectively and responsibly use AI-powered tools to enhance productivity, support decision-making, and improve work quality.

Preferred Qualifications

• Experience processing Long Term Care, health, disability, or related insurance reimbursement claims.
• Knowledge of insurance benefits, reimbursement methodologies, and claim payment calculations.
• Experience working in a customer-focused environment requiring provider and insured interaction.

The expected salary range for this position is $47 ,000 - $62,700 . This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.
Benefits We Offer
Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, paid time off, paid holidays, volunteer time off, tuition assistance and much more! For more information regarding MetLife's U.S. benefits, please click here .
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces™, as well as the Fortune 100 Best Companies to Work For®, 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.
As part of our New Frontier strategy, MetLife is building an AI-enabled, people-centered future. We're looking for people who bring curiosity, adaptability, and a growth mindset as we use AI to enhance how we serve customers, support communities, and evolve the way work gets done. At MetLife, AI is a responsible partner that supports human judgment, creativity, and continuous improvement while helping us build trust, inclusion, and long-term value.
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!
MetLife 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 [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.
This posting is for a current vacancy and is anticipated to remain open for at least 90 days from the listed posting date.