Supports MetLife Long Term Care Claims Operation by providing exemplary customer service while managing daily tasks assigned and performing other related duties as required.
Roles & Responsibilities
Provides plan and 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.
Responds to telephone inquiries from insured’s regarding specific claim details.
Understands processes within entire department to assist callers with questions and triage information received.
Works closely with the Claims Reimbursement and Care Managers to provide a seamless customer experience.
Outbound calls and letters to customers and providers to research incomplete claims.
Escalate complaints and potential complaints appropriately
Contributes ideas that enhance service quality.
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 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.
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
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