Specialist
Apply now »Date Posted: May 15, 2023
Location(s): Noida, IN
Company: MetLife
Basic Function:
Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and
state regulatory and/or company plan requirements and established FMLA workflow procedures
Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee,
physicians office or employer through outgoing calls, email, fax or other supporting systems.
Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans
and make initial claim decision.
Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW
confirmation, return phone calls, etc.
Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
The position is expected to do absence management and adjudication on Federal, State and company leaves.
Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees,
employers/customer and physician’s office
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, Performance Guarantee 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.
Skills:
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 in production driven
environment
Adaptability to change
Ability to work on routine/standardized transactions
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, specifically disability, preferred
Working knowledge of FMLA/Disability/Leave procedures
preferred
Knowledge of system applications preferred
Education Requirements
Graduate with at least 15 years of education.
Work Experience Requirements
Minimum 3-4 years of experience in a transactional, blended process of insurance or related industry with
relevant experience of working in a business environment (preferred but not compulsory)