Sr. Insurance Associate

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

Full time