Job Description – Dental Business Procedure Consultant

Position Title

Dental business procedures

Function, Responsibility Level

Operations

Reports to

Unit Manager / Manager

Approved By:

Span of Control

0                              

Location - MetLife GOSC

Permanent/ Temporary

Permanent

Basic Function

• To manage dental business procedures of Dental claims in partnership with stateside
• This role will document new or revise guidelines for process, procedures and initiatives to support dental claim operations in all areas of claim management.

Essential Functions

• Documents all standard and non-standard Dental process guidelines and correspondence within the Group Dental Product. Able to document business requirements into efficient process steps and actions for the development of guidelines. 
• Assist with the management, processing and documentation of customer variances from a process and correspondence perspective.
• Ensure that requested updates are handled timely and accurately and meeting our customer needs while remaining within all compliance and regulatory requirements.
• Review, investigate and respond to questions related to individual change requests. Identify gaps in content and/or inefficiencies in proposed process and recommend alternative solutions.
• Work with multiple partners for investigation, analysis, and development of nonstandard process and/or correspondence requests including but not limited to claim operations, customer delivery and legal. Works with all parties to ensure agreement and sign off on final outcome. 
• May communicate information to requestors and other business partners to help resolve inquiries related to a requested change for process and/or correspondence. 
• Performs other duties as assigned or required

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

Primary Internal Interactions

• Unit Manager / Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.
• Unit Manager / 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 process owner for business discussion.

Essential Business Experience and Technical Skills:

Required:

• 3-5 years of Group Life or Group Dental claims management experience. Expert knowledge/experience level of varied process/products, Federal and State regulations, claim management and correspondence systems. 
• Excellent verbal & written communication skills/ content writing 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.

Preferred

• Able to work with various company databases (SharePoint, Livelink), Webex and Microsoft program suite (Word, Excel).

Pre-requisite

Educational Qualification

• Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.
• Excellent verbal & written communication skills
• Proficient in usage of MS Office suite

Work Experience Requirements:

Experienced:

3 - 5 years of experience in Dental claims adjudication

Organizational Relationships

Reports To: Unit Manager / Manager                                                                                          Supervises: 0

Skills

Technical Skills

• Good computer navigation skills
• Good keyboarding speed
• Excellent 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 Dental 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
• Data gathering ability/ Eye for detail
• Team work/ Managing Self / Adaptability
• Highly organized with ability to work independently
• Prioritize work to meet changing business needs, timelines, goals and metrics. (Project management skills)
• Adaptability to change

Soft Skills (Desired)

• Self disciplined and result oriented
• Ability to multi task
• Familiarity with Dental Terminology

Education Requirements

• Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.(Candidates with B.Tech, MBA, BCA, or with any technical education would not be required)

Work Experience Requirements

3 – 5 years of experience in Dental claims management & process documentation.   

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.