Dental Claims & Services operations is the MetLife correspondence queues contain processing of dental claims basis the response received from the customer and review the email queries in detail and provide correct response following thorough research for all dental products.
Claims are thoroughly researched and reviewed to determine approval, non‑payment, referral, or the need for additional information. Email inquiries typically involve questions about coverage, claims status, policy status, and Met Dental profile–related issues.
Job Responsibilities
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
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
