Specialist
- Metlife
- 2 - 7 years
- Noida, Gurugram
- 4 hours ago
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Job Description
Description and Requirements- Analyze and process claims in a productive environment through our TLC claim system, SIR, plan specs and specimen policy
- Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and overpayments
- Review claims for receipt of all needed documentation and make outbound calls to providers for additional information
- Collaborate with our Claim Support Specialists, Customer Call Center and Care Coordinators to provide a seamless claims experience
- Abide by department guidelines and appropriately follow up on necessary tasks to process claims
- Meet quality review standards of processed claims
- Meet performance standards for financial accuracy, processing accuracy and claim timeliness
- Respond to insured inquiries regarding specific claim details via telephone conversations and/or written correspondence
- Gather and analyze information skillfully to identify and resolve problems in a timely manner
- Analyze and research all discrepancies
- Research & Investigate and resolve outstanding items
- Understand & interpret policy provision, determine 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
- 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.
- 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)
- Communication skills should be able to read, interpret business documents. Good verbal/written communication
- Excellent analytical, mathematical and interpersonal skills
- Data gathering ability/ Eye for detail
- Ability to comprehend and apply varied rules to multiple policies
- Team work/ Managing Self / Adaptability
- Ability to work successfully and perform detail-oriented work in production driven environment
- Excellent organizational skills
- Proven ability to meet quality and time standards
- Ability to work on routine/standardized transactions
- Ability to be flexible with regard to process changes
Education Requirements
Graduate with at least 15 years of education.
Work Experience Requirements
- Atleast 2 years of experience in claim environment
Job Classification
Industry: InsuranceFunctional Area / Department: Human ResourcesRole Category: HR OperationsRole: Background VerificationEmployement Type: Full timeContact Details:
Company: MetlifeLocation(s): Noida, Gurugram
Keyskills: MS Office suite Outbound Interpersonal skills Claims Analytical Process excellence TLC Research Management Quality Review
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