Sr Insurance Associate

Description and Requirements

• 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

Education

Experience

Knowledge and skills

• (general and technical)