Insurance Associate

Position Summary

Eligible associate will perform dual role of processing dental claims basis the response received from the customer and handle customer service inquiries via the telephone and/or email and answer questions or resolve problems.

Backend Profile - All the claims which cannot be processed by the sub-contractor, comes in Metcor 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

Voice Profile - Use computerized systems for tracking, information gathering, and/or troubleshooting.  Maintain quality service by following policies and procedures and reporting needed changes. And, contribute to team effort by accomplishing related results as needed

Job Responsibilities

Backend Profile

• Scrutinizing dental claim documents & settlements
• Process claims as per the set healthcare guidelines
• Follow HIPPA guidelines
• Accurate processing of Dental claims
• 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

Voice Profile

• Will handle customer service inquiries via the telephone and/or email and answer questions or resolve problems from Dental offices
• Use computerized systems for tracking, information gathering, and/or troubleshooting
• Maintain quality service by following policies and procedures and reporting needed changes, and contribute to team effort by accomplishing related results as needed
• The successful candidate will leverage effective listening skills, an attention to detail, strong intellectual curiosity and an honest desire to make a difference to ensure each customer experience is exceptional
• With an understanding of the customers’ needs and wants, and a focus on delivering solutions that meet those needs, you will deliver a service experience that exceeds expectations and makes it easy for customers to do business with us
• Scrutinizing dental claim documents & settlements

Knowledge, Skills and Abilities

Education

Bachelor’s degree (Any Stream) or

Diploma with a minimum of 15 years of education

Experience

1 + years customer service experience

1 + years of work experience in US Healthcare Insurance

An ability to work during the hours of operation of Monday-Friday 8am-11pm EST; must be flexible regarding shifts worked, which may change based on business needs

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

Soft Skills

·        Strong organizational skills

·        Demonstrate ability to work independently and in a team environment

       Superb listening skills and professional oral & written    communication skills with an ability to inspire trust and accountability though an empathetic communication style which promotes a quality image of MetLife

·        Self-disciplined and results oriented

·        Ability to multitask

·        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):

·         Asst. Manager 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 and monthly evaluation of performance

·         Quality Compliance Analyst (QCA) for the purpose of feedback and audit

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