Passer au contenu
Pays
Inde
Horaires de Travail
Temps plein
Arrangement de Travail
Hybride
Aide à la réinstallation possible
Non
Date d'envoi
16-jan-2025
ID de l'emploi
6112

Description et exigences

 

Job Description LTC Claims – Plan of Care

Position Title:

Senior Case Management Specialist

Function, Responsibility Level:

Operations, Executive

Reports to (Responsibility Level):

AM

Supervises:

Individual Contributor

Location:

MGOSC MCC1

Global Grade:

Grade 9

Cost Center (85 series):

NA

Complexity:

C5T4

PID/s Load Mapping:

NA

Role Value Proposition

Provides administration of benefits for Long-Term Care Insurance. Administration includes determination of benefit eligibility,

information and referral, care management, insured advocacy, provider verification, claim processing and customer service.

Roles & Responsibilities

• Handles incoming calls through the claim toll free lines.

• Provides plan and claim information, assists with submission of claims and makes outbound calls to gather missing

information on incomplete claims.

• Conducts research when needed to resolve customer questions or complaints.

• Able to appropriately explain varying plan provisions to customers accurately and in a professional manner.

• Responds to telephone inquiries from insureds regarding specific claim details.

• Understands processes in entire department to assist callers with questions.

• Works closely with the claim analysts and care managers to provide a seamless customer experience.

• Outbound calls and letters to customers and providers to research incomplete claims and update the insured Plan of

Care with current providers.

• Works the Plan of Care Task List based on tasks sent from our call center team.

• Work Plan of Care email bucket daily with correspondence received both from internal and external customers.

• Escalates complaints and potential complaints appropriately.

• Documents calls in computer system.

• Completes form letters, tasks and problem solve for resolution of customer issues.

• Contributes ideas that enhance service quality.

• Works daily Metrics reports to ensure a referral is needed and complete the referral with third party vendors.

• Assist the claims payment team by reviewing and updating daily tasks.

• Performs project work and other related duties as assigned or required

Essential Functions:

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)

• Analyze and research all discrepancies

• Research & Investigate and resolve outstanding items

• Determine eligibility, 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

• Establish action plans for each file to bring claims to resolution

• Utilize internal and external specialty resources to maximize impact on each claim file

• Use PC programs to increase productivity and performance

• 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.

Primary Internal Interactions

• UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support

• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance

• Subject Matter Expert for the purpose of work thread related issues and escalated transactions

• QCA for the purpose of feedback

• Trainers • for the purpose of training

Primary External Interactions

• Interaction with Insureds via incoming and outgoing calls information gathering/ claim queries

• Claims specialist & other Stateside Teams on emails/calls

• SME / Trainers at the client end for training

Organizational Relationships

Reports To:

AM, LTC Claims Process – Plan of Care

Supervises:

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)

Mandatory:

• Communication skills – should be able to read, interpret

business documents. Good verbal/written communication

• Proficiency in English – Spoken and Written

• Analytical and interpersonal skills

• Escalate issues if required

• Data gathering ability/ Eye for detail

• Team work/ Managing Self / Adaptability

• Ability to work successfully and perform detail-oriented work

in production driven environment

• Ability to work on routine/standardized transactions

• Ability to be flexible with regard to process changes

• Self disciplined and result oriented

• Ability to multi task

• Ability to work effectively as part of a team

Desired:

• Knowledge of Medical Terminology (preferred but not

compulsory)

Preferred:

• Claims knowledge preferred

• Knowledge of system applications preferred

Education Requirements

Graduate with at least 15 years of education.

Work Experience Requirements

- 2+ years of customer service experience

About MetLife

Recognized on Fortune magazine's list of the 2024 "World's Most Admired Companies" and Fortune World’s 25 Best Workplaces™ for 2024, 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 empathy, we’re inspired to transform the next century in financial services. 
At MetLife, it’s #AllTogetherPossible. Join us!