Job Description – (IC role)

Position Title 

AMS PG Consultant

Function, Responsibility Level

Operations,  Executive

Reports to

Manager/ Sr. Manager 

Approved By: 

Span of Control 

0                               

Location - MetLife GOSC

Permanent/ Temporary

Permanent

Basic Function

·       Quality Auditor must be proficient with all claims systems (DPA, Intellis, SIR, UIS, Quadient, AbsTracks).

·       Must be proficient in all AMS claim types (FML, PFML, Company Leaves). 

·       Must have working knowledge of all regulations for FML and state PFML claims. 

·       Must be able to navigate the CMG to reference specific claim processes as well as utilize customer folders to obtain process variance documentation and contractual plans, interpret plan language and provisions.

·       Strong writing skills as coaching is provided in the audit worksheet..

Essential Functions

·       Under immediate supervision, evaluates and improves business processes and associate performance by effectively conducting a statistically valid sample of quality evaluations for a basic to moderate set of operational transactions.

·       Provides timely and meaningful feedback to associates and management with regards to performance and quality standards

·       Assistance in conducting research, gathering quality information and the production of reports that provide key quality improvement and cost reduction opportunities.

·       Assistance in identifying trends, root causes and quality gaps from the analysis of data to improve the customer experience.

·       Continuously communicates areas of opportunity to the leadership.

·       May assist with identifying and recommending process improvements or training needs utilizing root Causeway analysis methodology.

·       Establish action plans for each observation to bring claims to resolution

·       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 while demonstrating core values and meeting key measures

·       Ensure adherence to established attendance schedules 

Any other essential function that may occur from time to time as directed.

Primary Internal Interactions

·       Manager/ Sr. Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.

·       Manager for the purpose of settling issues left unresolved and monthly evaluation of performance.

·       Stateside Auditors for the purpose of seeking cooperation & clarification on process-related matters & providing assistance and support when required.

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

·       Trainers for the purpose of Pre-process and Process training.

Primary External Interactions

·       Stateside Quality Manager / Process owner at the client end for business discussion.

Essential Business Experience and Technical Skills: 

Required: 

·       3-5 years of AMS claims management experience.

·       Expert knowledge of AMS process, Federal/State regulations, plan provisions and all disability claim management and correspondence systems.

·       Excellent written communication skills 

·       Highly organized; able to work independently and prioritize work to meet changing business needs, timelines, goals and metrics.

·       Demonstrated leadership skills and self-direction a must.

·       Demonstrated ability to manage multiple, completing priorities.

Pre-requisite

Educational Qualification

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

·       Excellent verbal & written communication skills

·       Knowledge/experience of AMS Claims

Work Experience Requirements:

Experienced:

3 - 5 years of experience in AMS claims adjudication

Organizational Relationships

Reports To: Manager/Sr.Manager                                                                                          Supervises: 0

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.

·       End to end product knowledge on AMS required

Soft skills (Minimum)

·       Proficiency in English language both written & verbal skills

·       Excellent Communication skills – should be able to read, interpret business documents. 

·       Analytical and interpersonal skills

·       Escalate issues if required

·       Data gathering ability/ Eye for detail

·       Team work/ Managing Self / Adaptability

·       Ability to work successfully in production driven environment

·       Adaptability to change

·       Ability to work on routine/standardized transactions

Soft Skills (Desired)

·       Self disciplined and result oriented

·       Ability to multi task

·       Ability to work effectively as part of a team

·       Familiarity with AMS Terminology

Education Requirements

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

Work Experience Requirements

3 – 5 years of experience in AMS claims management 

Enclosures: 

Acknowledgement (acknowledge that the information contained in this document is factual and complete)

___________________________________                          

 Candidate                                                                             Manager                               Date

MetLife Values :

Core Values:

The employee should adhere to MetLife Core values:

People Count - It's all about people… MetLife's key resource.  MetLife will succeed in the marketplace because we are winning from within. 

Integrity and Honesty - Conducting our business endeavors with truth, sincerity and fairness. 

Innovation - Continuously creating and introducing new and original ideas and ways of doing things. 

Financial Strength - Operating with an intense dedication to managing monetary resources for strong business results. 

Partnership - Functioning productively in teams towards a common purpose-realizing the collective power of diverse work groups. 

Personal Responsibility - "Coming into your own"-performing as a leader to be really effective and successful-by acting and making decisions independently to get results.