Insurance Associate.

3 weeks ago

Noida, India MetLife Full time

Basic Function

Responsible for structuring Long-Term Disability (LTD) claims based on claim receipt date. Support the claim adjudication (claim specialist) team with the initial claim setup in accordance with the plan provisions, identify potential recurrent claims, and utilize several systems to verify coverage. Determine LTD eligibility. Prepare and send acknowledgment to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD - stand-alone & bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, Claims Manager (stateside supervisors), EE, ER through emails/systems. Assign the claims to the CS in case missing along with declining the duplicates and send back claims. Capture details directly from Claimant & ER for CCU No Call work and observe these claims for 3 days consecutively

Essential Functions

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)

• Analyze and research all discrepancies.

• Research & investigate and resolve outstanding items

• Determine eligibility and applicable plan provisions while meeting timeliness goals

• Clear and accurate written and verbal communication (Scripted and Templatized) with employee,
employer & stateside resources by email

• Establish action plans for each file to bring claims to resolution

• Utilize internal and external specialty resources to maximize impact on each claim file

• Utilize Intellis and ACS (SIR) to update and maintain accurate data record

• Use PC programs to increase productivity and performance

• Ensure that the assigned targets are met in accordance with SLA and Internal standards

• Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process
Excellence

• Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values
and meeting key measures.

• Ensure adherence to established attendance schedules

• Sedentary work - involves sitting most of the time

• Close visual acuity - viewing a computer terminal and extensive reading

• Talking - expressing or exchanging ideas by means of the spoken word

• Capturing the medical, personal & employment details from Employee, Health Care Provider(via email - free flow communication)

MetLife:

MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits and asset management to help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.

We are ranked #44 on the Fortune 500 list for 2019. In 2019, we were named to the Dow Jones Sustainability Index (DJSI) for the fourth year in a row. DJSI is a global index to track the leading sustainability-driven companies.

MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.

MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

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