Leave Solutions Operations Director

Job Summary:

The Leave Solutions Claim Director is responsible for overseeing the end-to-end management of Short-Term Disability, Absence, ADA, State and Company leaves, ensuring compliance with regulatory requirements, optimizing operational efficiency, and driving best-in-class claims outcomes. This role involves leading a team of claims professionals, developing policies and procedures, managing risk, and collaborating with internal and external stakeholders to enhance claims management processes. This role requires expertise in claims processing, team leadership, and project management to drive continuous improvements and optimize workflows as well as enhanced understanding of operational financial controls and budget management.

Key Responsibilities:

Leadership & Team Management:

• Lead, mentor, and develop a team of Leave claims professionals, including Managers, associate managers, and claims specialists.

• Foster a culture of continuous improvement, collaboration, and accountability.

• Provide strategic direction and guidance to ensure the team meets performance metrics and service level agreements.

• Accountable for building and scaling disability teams to provide comprehensive domestic support across West Coast and Central time zones

Claims Management Oversight:

• Oversee the evaluation, adjudication, and resolution of Leave claims to ensure fair, accurate, and timely decisions.

• Ensure compliance with regulatory guidelines, insurance policies, and company procedures.

• Monitor claims trends, risk exposure, and potential fraud indicators.

Process Improvement & Operational Efficiency:

• Develop and implement best practices to improve claims processing efficiency and accuracy.

• Leverage data analytics and technology to enhance decision-making and claims outcomes.

• Identify and address operational bottlenecks to improve workflow and customer experience.

Regulatory & Compliance Management:

• Ensure adherence to federal, state, and local regulations (e.g., ERISA, ADA).

• Work closely with legal and compliance teams to mitigate risks and address regulatory concerns.

• Stay updated on industry changes and regulatory updates impacting Leave claims.

Stakeholder Collaboration & Communication:

• Partner with underwriting, legal, actuarial, and customer service teams to ensure alignment of claims strategies.

• Engage with external vendors, medical professionals, and policyholders to facilitate claim resolutions.

• Provide executive leadership with reports on claims performance, trends, and strategic initiatives.

Financial & Risk Management:

• Ensure accurate claim payments and decisional forecasting.

• Develop risk mitigation strategies to control claims costs and reduce unnecessary payouts.

• Work with financial partners to allocate staffing and manage a defined budget.

Qualifications & Experience:

Required

• 8-10+ years of experience in disability claims management, with at least 5 years in leadership roles.

• Strong knowledge of Disability and Leave policies, claims processing, and industry regulations.

• Experience with claims management systems and data analytics tools.

• Excellent leadership, decision-making, and communication skills.

• Ability to drive process improvements and manage change effectively

Preferred

• Bachelor's degree in business, Insurance, Risk Management, or a related field

• Six Sigma Certificate

Equal Employment Opportunity/Disability/Veterans

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.