General Information
Location: Jaipur, Rajasthan
Working Schedule: Full time
Work Arrangement: Hybrid
Relocation Assistance Available: No

Job Summary

Position Title: Associate/Sr. Associate

Function, Responsibility Level: Operations, Associate

Reports to (Responsibility Level): TL / AM / UM

Supervises: NA

Location: Noida

Global Grade: 08M

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




Positive understanding of Claims adjudication fundamentals
Positive 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

Education

Bachelor's degree (Any Stream) or diploma with a minimum of 15 years of education

Experience

2 years of work experience in US Health Claims processing preferably in claims adjudication

Knowledge, Skills and Abilities
Computer navigation skills
Keyboarding and data entry speed (minimum 30 wpm)

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Sr Insurance Associate Jaipur
🏢 MetLife
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