Position Summary
The Metcor 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 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.
Job Responsibilities
1. Scrutinizing dental claim documents & settlements
2. Process claims as per the set healthcare guidelines
3. Follow HIPPA guidelines
4. Accurate processing of Dental claims
5. Good understanding of ICT & CPT Codes
6. Knowledge of policy concepts like Deductible, coinsurance, copay, out of pocket
7. Able to learn, adapt, implement process guideline into practice, work as a natural team-player in the
process
8. Handle escalations
9. Need to ensure quality and productivity targets are met
10. 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
1-2 years of work experience in US Healthcare Insurance
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
· 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
Working Relationships
Internal Contacts
(and purpose of relationship):
· AM 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
mrtlifeins@metlife.com
