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Todas las ciudades
Noida
País
India
Acuerdo de trabajo
Tiempo completo
Esquema de Trabajo
Híbrido
Asistencia de reubicación disponible
No
Fecha de publicación
17-Jul-2024
ID del trabajo
3452

Descripción y requisitos

Position Title: Associate/Sr. Associate

 

Function, Responsibility Level: 
Operations, Associate

 

Reports to (Responsibility Level): TL / AM / UM

 

 

Supervises: NA

 

Location: Noida

 

Global Grade:

 

08M

 

Cost Center:

 

-

Complexity:

 

T4C4

PID/s Load Mapping:

NA

Position Summary

Metrefer/Dental Claims Operations is the MetLife correspondence queues contain processing of dental claims basis the response received from the customer. All the claims which cannot be processed  by the sub-contractor, comes in Metrefer/Dental Claims Operations 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.

 

Job Responsibilities

 

  • Scrutinizing dental claim documents & settlements
  • Process claims as per the set healthcare guidelines
  • Follow HIPAA guidelines
  • Accurate processing of Dental claims and meeting productivity targets
  • Good understanding of Claims adjudication fundamentals 
  • 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

 

Knowledge, Skills and Abilities

 

 

 

Education

  • Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education

 

 

Experience

  • 2 years of work experience in US Health Claims processing preferably in claims adjudication

 

 

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
  • Knowledge of Dental claims terminologies and processes will be an added advantage 

Soft Skills

  • Strong organizational skills
  • Good communication skills
  • Demonstrate ability to work independently and in a team environment
  • Self-disciplined and results oriented
  • Ability to multi task
  • 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):

 

  • AM/TL 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/TL and monthly evaluation of performance.
  • Quality Compliance Analyst (QCA) for the purpose of feedback and audit.
  • Trainers for the purpose of pre-process and process training.

 

 

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.

 

 

 

 

 

 

 

 

 

Enclosures:

 

 

MetLife Values:

Our purpose and values

Our purpose is why we are in business and reflects what we stand for and believe in. Our purpose is to help people pursue more from life. Our values are how we achieve that purpose, through an expression of who we are, what we stand for as a company and how we conduct our business:

Customers First

Put Customers First 
 Caring for and respecting customers is core to everything we do. It defines our work and shapes the culture for our people, radiating out to our shareholders and communities.

Be The Best

Be The Best 
 We are relentless in our search for new and better ways of doing things. As a leader in our industry, we constantly raise the bar, take calculated risks and learn quickly from our mistakes.

Make Things Easier

Make Things Easier 
 Products in our industry aren't always easy to understand. That's why we are always looking for simpler ways to connect customers to the best solutions. By doing this, we aim to exceed their expectations and build trust.

Succeed Together

Succeed Together 
 United by our purpose, we live by a collective commitment to honesty, integrity and diversity. We are open and inclusive, proudly taking and applying the best ideas from every part of our company.


 

Acerca de MetLife

Reconocida en la lista de la revista Fortune de las "Empresas más admiradas del mundo" de 2023, MetLife, a través de sus subsidiarias y afiliadas, es una de las empresas de servicios financieros líderes en el mundo; proporcionando seguros, anualidades, beneficios para empleados y gestión de activos a clientes individuales e institucionales. Con operaciones en más de 40 mercados, ocupamos posiciones de liderazgo en Estados Unidos, América Latina, Asia, Europa y Medio Oriente.

Nuestro propósito es simple: ayudar a nuestros colegas, clientes, comunidades y al mundo en general a crear un futuro más seguro. Unidos por un propósito y guiados por la empatía, estamos inspirados para transformar el próximo siglo en servicios financieros. En MetLife, es #AllTogetherPossible. ¡Únete a nosotros!