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, professional manner while exercising robust 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

📌 Specialist (Noida)
🏢 MetLife
📍 Noida