Insurance Associate_Dental Claims

Description and Requirements
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

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
• Knowledge of Dental claims terminologies and processes will be an added advantage

Soft Skills

• Strong organizational skills
• Good communication 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/TL 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/TL and monthly evaluation of performance.
• Quality Compliance Analyst (QCA) for the purpose of feedback and audit.
• Trainers for the purpose of pre-process and process training.

External Contacts
(And purpose of relationship) - If Applicable

• MetLife Subject Matter Experts for the purpose of seeking missing information.
• MetLife Subject Matter Expert for the purpose of work-related issues and escalated transactions.

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