Sr Insurance Associate

Position Summary

§  The primary function of the Nurse Reviewer is to evaluate individual Statement of Health applications for Life coverages for Group customer. Also determine the need for additional medical information and decision making regarding the insurability of an applicant based on MetLife’s Medical Underwriting Guidelines. Provide guidance to SOH Reviewer 1 & 2 on as is basis.

Job Responsibilities

• Interpret customer Statement of Health provisions and process accordingly.  Determine the insurability of the financial risk, based on the initial review of Statement of Health, and all medical information provided.
• Evaluate Statement of health forms to identify situations requiring referral to Medical Underwriter.
• Review all appeals for requested coverage after the application was denied and the appeal received.
• Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction is met. While maintaining production and quality standards.
• Keep up to date on Statement of Health procedures by using the Institutional Statement of Health Library and attending required training.
• Identify and obtain missing information required to evaluate Statement of Health form from Web based system, (SIR) and input missing information into Windows based computer system, (StarTrak).
• Evaluate individual applications for group life and group disability coverage and make decisions regarding approval, denial, the need for further investigation in the form of medical records or exams.
• Mentor/Job Coach new Reviewers on Statement of Health procedures and workflow.

Knowledge, Skills and Abilities

Education

• Graduates or Diploma holders with at least 15 years of education, which is 12 years of school and 3 years of college education

·         Graduation or Diploma in Bio-Sciences (Bachelor in Pharmacy, Degree in Biotechnology, Degree in Biochemistry / Microbiology / Nursing, Diploma in Pharmacy)

Experience

·         Preferred up to 12 months of work experience in a Hospital, BPO or Medical Transcription or medical underwriting process

Knowledge and skills (general and technical)

·         Good computer navigation skills

·         Working knowledge of MS Excel and MS Word.

·         Key boarding Skills not required as this is not a Data Entry Job.

·         Knowledge about US Culture

·         Judgment and decision making

·         Knowledge of medical underwriting process

·         Problem solving skills

·         Ability to multitask

·         Knowledge of Medical Terminology

·         Awareness of US insurance industry

Other Requirements (licenses, certifications, specialized training – if required)

·         Diploma/Degree in pharmacy, Nursing.