- Índia - 3452 - MetLife

Todas as cidades

Noida

País

Índia

Arranjo de trabalho

Tempo integral

Modelo de Trabalho

Híbrido

Assistência de realocação disponível

Não

Data de publicação

17-Julho-2024

ID da vaga

3452

Descrição e 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:

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:

	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 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 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 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.

About MetLife

Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World’s 25 Best Workplaces™, 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 our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we’re inspired to transform the next century in financial services. At MetLife, it’s #AllTogetherPossible. Join us!