MetLife

·       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.

·       Responds to telephone inquiries from insured’s regarding specific claim details.

·       Understands processes within entire department to assist callers with questions and triage information received.

·       Works closely with the Claims Reimbursement and Care Managers to provide a seamless customer experience.

·       Outbound calls and letters to customers and providers to research incomplete claims.

·       Escalate complaints and potential complaints appropriately

·       Contributes ideas that enhance service quality.

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

·       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 

·       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