Sr Insurance Associate

Position Summary

Dental Claims & Services operations is the MetLife correspondence queues contain processing of dental claims basis the response received from the customer and review the email queries in detail and provide correct response following thorough research for all dental products.

Claims are thoroughly researched and reviewed to determine approval, non‑payment, referral, or the need for additional information. Email inquiries typically involve questions about coverage, claims status, policy status, and Met Dental profile–related issues.

Job Responsibilities

• Scrutinizing dental claim documents & settlements
• Process claims as per the set healthcare guidelines
• Respond to customer requests via multiple sources, providing excellent service to MetLife's customers who have insurance or other financial service products or benefit plans.
• Research requests regarding various product aspects, policy provisions, claim status, basic procedures, etc.
• Follow HIPAA guidelines
• Accurate processing of Dental claims and meeting productivity targets
• Good understanding of Claims adjudication fundamentals
• 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
• Efficiently access and navigate multiple electronic systems to provide a complete and integrated response to the customer's inquiry.
• Handle escalations
• Need to ensure quality and productivity targets are met
• Ensure compliance with internal policies and procedures, external regulations and information security standards
  
  

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
• Knowledge of Dental claims terminologies and processes will be an added advantage
• Written- External/Internal (Free Flow) Email Writing
• Free flow correspondence creation
• Excellent comprehension skills – Interpret/analyze data from various resources , understands , documents and responds appropriately
  
  

Soft Skills

• Strong organizational skills
• Excellent Language skills (written ,verbal and comprehension)
• Demonstrate ability to work independently and in a team environment
• Self-disciplined and results oriented
• Ability to multi task
• Strong understanding and comprehension of the English language
• Good PC skills
• Attention to detail
• Team player
• Positive attitude