Position Summary The Specialist/Provider Control Unit Reviewers would require assessing the reason for Claim adjudication failure. Follow the documentation to research various MetLife databases / systems or call relevant parties to seek the correct information. The Job of the Reviewer is to rectify and correct the information for a seamless Claims processing.

This will require the Reviewer to gather the information from Metlife application and calling the providers/ providers office etc. The calls in scope are B2B calls Job Responsibilities Interacts with multiple internal and external partners

Corresponds with providers, providers office, to gather necessary information, clarify details to ensure correctness of the records in various reference systems for Claims processing

Respond to incoming calls from providers & make outbound calls to providers / provider office /dentists

Create, update, and maintain provider records in internal systems

Conduct research in multiple systems to resolve the discrepancies in provider information (submitted Claims vs referral systems)

Utilizes multiple mainframes, PC, and Internet based systems

Validate/ update provider information (billing and rendering) for accuracy, completeness and eligibility according to established guidelines to support claim processing

Efficiently update system logs basis the call / action taken





Efficiently access and navigate multiple applications to gather and assess information

Efficiently coordinate with process associates in prescribed scenarios i.e.

Any other essential function that may occur from time to time as directed by the Supervisor

Perform these responsibilities in a consistent, skilled manner while exercising strong verbal, written, and high-quality service skills Essential Functions Semi scripted calling (outbound 50% & ~10% inbound calls) should be fluent in speaking & writing English Ability to interact & connect with Provider over a call

Excellent comprehension skills – Interpret/analyze information from various resources, problem solving and responds appropriately

Computer navigation skills, multiple application

Should be comfortable working on 2 to 3 computer screens

Ability to research & take decision to resolve problem

Analytical and eye to details to find discrepancy in the information

Prefer to have knowledge of Insurance principles in relation to the US Insurance industry

Knowledge about US Culture. Strong organizational skills

Demonstrate ability to work independently and in a team environment

Self-disciplined and results oriented, ability to multitask

Must be open to work in rotational shifts X 5 days work from office

📌 Specialist (Noida)
🏢 MetLife
📍 Noida