Sr. Insurance Associate

General Information

Location: Jaipur, Rajasthan

Working Schedule: Full-Time

Work Arrangement: Hybrid

Relocation Assistance Available: No

Position Details

Position Title: Associate/Sr. Associate

Function, Responsibility Level: Operations, Associate

Reports to (Responsibility Level): TL / AM / UM

Supervises: NA

Location: Noida

Global Grade: 08M

PID/s Load Mapping: NA

Complexity: T4C4

Cost Center: -

Position Summary

Metrefer/Dental Claims Operations is the MetLife correspondence queues contain processing of dental claims basis the response received from the customer. All the claims which cannot be processed by the sub-contractor, comes in Metrefer/Dental Claims Operations 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.

Job Responsibilities

• Scrutinizing dental claim documents settlements
• Process claims as per the set healthcare guidelines
• 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
• Handle escalations
• Need to ensure quality and productivity targets are met
• Ensure compliance with internal policies and procedures, external regulations and information security standards

Knowledge, Skills and Abilities

Education

Bachelor s degree (Any Stream) or diploma with a minimum of 15 years of education

Experience

2 years of work experience in US Health Claims processing preferably in claims adjudication

Technical Skills

• Computer navigation skills
• Keyboarding and data entry speed (minimum 30 wpm with 90

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.