MetLife
Website:
metlife.com
Job details:
Requirements
Description and Requirements
Roles & Responsibilities
- Analyze and process claims in a productive environment through our TLC claim system, SIR, plan specs and specimen policy
- Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and overpayments
- Review claims for receipt of all needed documentation and make outbound calls to providers for additional information
- Collaborate with our Claim Support Specialists, Customer Call Center and Care Coordinators to provide a seamless claims experience
- Abide by department guidelines and appropriately follow up on necessary tasks to process claims
- Meet quality review standards of processed claims
- Meet performance standards for financial accuracy, processing accuracy and claim timeliness
- Respond to insured inquiries regarding specific claim details via telephone conversations and/or written correspondence
- Gather and analyze information skillfully to identify and resolve problems in a timely manner
Essential Functions:
- Analyze and research all discrepancies
- Research & Investigate and resolve outstanding items
- Understand & interpret policy provision, determine entitlement and applicable plan provisions while meeting
timeliness goals
- Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
- Ensure that the assigned targets are met in accordance with SLA and Internal standards
- Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
- Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and
meeting key measures
- Ensure adherence to established attendance schedules
- Close visual activity - viewing a computer terminal and extensive reading
Any other essential function that may occur from time to time as directed by the Supervisor.
Skills
Technical Skills
- Good computer navigation skills
- Good keyboarding speed
- Good knowledge of complete MS Office suite
Process Specific Skills
- Knowledge about the Insurance industry in US
- Knowledge about US Culture
- Knowledge of Insurance principles
Soft Skills (Mandatory / Desired)
- Communication skills – should be able to read, interpret business documents. Good verbal/written communication
- Excellent analytical, mathematical and interpersonal skills
- Data gathering ability/ Eye for detail
- Ability to comprehend and apply varied rules to multiple policies
- Team work/ Managing Self / Adaptability
- Ability to work successfully and perform detail-oriented work in production driven environment
- Excellent organizational skills
- Proven ability to meet quality and time standards
- Ability to work on routine/standardized transactions
- Ability to be flexible with regard to process changes
Education Requirements
Graduate with at least 15 years of education.
Work Experience Requirements
- Atleast 2 years of experience in claim environment
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!
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