MetLife is an International company
Shift Timings – 17:30 – 2:30
Home Pick & Drop – Yes
Working Model – Hybrid
0 – 5 years
3.5-7 Lacs P.A.
Hybrid
Time and Venue
25 June – 27 June , 12.00 PM – 3.00 PM
MetLife GSS, Oxygen Business Park Private Ltd, Tower 2, Plot No. 07,Sector-144,Noida (Entry from Gate 3
Contact – Kuldeep Sharma
Job description
Primary External Interactions
- End customer to be contacted through emails/calls for information gathering
- Claims specialist & other Stateside Teams on emails/calls
- SME / Trainers at the client end for trainingP
- rimary 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 trainingRole Value Proposition
Provides support for the Long-Term Care Insurance claims operation. Administration includes provider verification, research, and customer service.
Roles & Responsibilities
- Provider Verification: Research providers to see if they meet requirements rules vary depending on state and policy provisions.
- Provider Verification Expiration Report- updates providers license/credentials that we currently pay claims.
- Provides 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.
- 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. 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.
- Performs project work and other related duties as assigned or required.
- Ability to read and properly interpret contract language.
- 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 disabilitys 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
- 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)
- • 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
- Desired:
- • Self disciplined and result oriented
- • Ability to multi task
- • Ability to work effectively as part of a team
- • 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
Role:
Voice / Blended – OtherIndustry Type:
InsuranceDepartment:
Customer Success, Service & OperationsEmployment Type:
Full Time, PermanentRole Category:
Voice / Blended
Education:
B.Sc in Any Specialization, B.A in Any Specialization, B.B.A/ B.M.S in Any Specialization, BHM in Any Specialization, B.Com in Any Specialization
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