Metlife
Location
Noida | India
Job description
Basic Function
Responsible for structuring Long-Term Disability (LTD) claims based on claim receipt date. Support the claim adjudication (claim specialist) team with the initial claim setup in accordance with the plan provisions, identify potential recurrent claims, and utilize several systems to verify coverage. Determine LTD eligibility. Prepare and send acknowledgment to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD - stand-alone & bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, Claims Manager (stateside supervisors), EE, ER through emails/systems. Assign the claims to the CS in case missing along with declining the duplicates and send back claims. Capture details directly from Claimant & ER for CCU No Call work and observe these claims for 3 days consecutively.
Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
. Analyze and research all discrepancies.
. Research & investigate and resolve outstanding items
. Determine eligibility and applicable plan provisions while meeting timeliness goals
. Clear and accurate written and verbal communication (Scripted and Templatized) with employee,
employer & stateside resources by email
. Establish action plans for each file to bring claims to resolution
. Utilize internal and external specialty resources to maximize impact on each claim file
. Utilize Intellis and ACS (SIR) to update and maintain accurate data record
. Use PC programs to increase productivity and performance
. Ensure that the assigned targets are met in accordance with SLA and Internal standards
. Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process
Excellence
. Work as a team member to meet office goals to obtain disability's vision while demonstrating core values
and meeting key measures.
. Ensure adherence to established attendance schedules
. Sedentary work - involves sitting most of the time
. Close visual acuity - viewing a computer terminal and extensive reading
. Talking - expressing or exchanging ideas by means of the spoken word
. Capturing the medical, personal & employment details from Employee, Health Care Provider(via email - free flow communication)
Job tags
Salary
