Location
Noida | India
Job description
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
- 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
- Handle escalations
- Need to ensure quality and productivity targets are met
- Ensure compliance with internal policies and procedures, external regulations and information security standards
Job tags
Salary
