Job title: Sr. Insurance Associate
Company: MetLife
Job description: Sr. Insurance Associate
Position Summary
Eligible associate will perform dual role of processing dental claims basis the response received from the customer and handle customer service inquiries via the telephone and/or email and answer questions or resolve problems.
Backend Profile – All the claims which cannot be processed by the sub-contractor, comes in Metcor queue. Work queues that have claims route to GOSC can be defined by the type of edit that requires resolution (eligibility, plan, provider or code related). Claims are researched and reviewed for approval, non-payment, referral or request for additional information
Voice Profile – Use computerized systems for tracking, information gathering, and/or troubleshooting. Maintain quality service by following policies and procedures and reporting needed changes. And, contribute to team effort by accomplishing related results as needed
Job Responsibilities
Backend Profile
- Scrutinizing dental claim documents & settlements
- Process claims as per the set healthcare guidelines
- Follow HIPPA guidelines
- Accurate processing of Dental claims
- Good understanding of ICT & CPT Codes
- Knowledge of policy concepts like Deductible, coinsurance, copay, out of pocket
- Able to learn, adapt, implement process guideline into practice, work as a natural team-player in the
- Process
- Handle escalations
- Need to ensure quality and productivity targets are met
- Ensure compliance with internal policies and procedures, external regulations and information security standards
Voice Profile
- Will handle customer service inquiries via the telephone and/or email and answer questions or resolve problems from Dental offices
- Use computerized systems for tracking, information gathering, and/or troubleshooting
- Maintain quality service by following policies and procedures and reporting needed changes, and contribute to team effort by accomplishing related results as needed
- The successful candidate will leverage effective listening skills, an attention to detail, strong intellectual curiosity and an honest desire to make a difference to ensure each customer experience is exceptional
- With an understanding of the customers’ needs and wants, and a focus on delivering solutions that meet those needs, you will deliver a service experience that exceeds expectations and makes it easy for customers to do business with us
- Scrutinizing dental claim documents & settlements
Knowledge, Skills and Abilities
Education
Bachelor’s degree (Any Stream) or
Diploma with a minimum of 15 years of education
Experience
1 + years customer service experience
1 + years of work experience in US Healthcare Insurance
An ability to work during the hours of operation of Monday-Friday 8am-11pm EST; must be flexible regarding shifts worked, which may change based on business needs
Knowledge and skills (general and technical)
Technical Skills
· Computer navigation skills
· Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)
· Working knowledge of MS Excel and MS Word.
· Process Specific Skills
· Knowledge of Insurance principles in relation to the US Insurance industry
· Knowledge about US Culture
Soft Skills
· Strong organizational skills
· Demonstrate ability to work independently and in a team environment
Superb listening skills and professional oral & written communication skills with an ability to inspire trust and accountability though an empathetic communication style which promotes a quality image of MetLife
· Self-disciplined and results oriented
· Ability to multitask
· Strong understanding and comprehension of the English language
· Good PC skills
· Attention to detail
· Team player
· Positive attitude
Working Relationships
Internal Contacts
(and purpose of relationship):
· Asst. Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support as well as associate development
· Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
· Quality Compliance Analyst (QCA) for the purpose of feedback and audit
External Contacts
(and purpose of relationship) – If Applicable
· MetLife Subject Matter Experts for the purpose of seeking missing information
· MetLife Subject Matter Expert for the purpose of work-related issues and escalated transactions
MetLife:
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 help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.
We are ranked #44 on the Fortune 500 list for 2019. In 2019, we were named to the Dow Jones Sustainability Index (DJSI) for the fourth year in a row. DJSI is a global index to track the leading sustainability-driven companies.
MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.
MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
Expected salary:
Location: Noida, Uttar Pradesh
Job date: Tue, 28 Jun 2022 22:05:12 GMT
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