Job Description

CountryIndiaWorking ScheduleFull-TimeWork ArrangementHybridRelocation Assistance AvailableYesPosted Date11-Aug-2024Job ID3938Description and RequirementsBasic FunctionResponsible 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 in 5-days to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD - stand-alone claims, bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, claim support specialist (QA), Claims Manager (stateside supervisors), EE, ER through emails/systems.Essential Functions

• 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

Any other essential function that may occur from time to time as directed by the Supervisor.Primary Internal Interactions

• AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.
• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.
• Subject Matter Expert for the purpose of work thread related issues and escalated transactions.
• QCA for the purpose of feedback and audit.
• Trainers for the purpose of Pre-process and Process training.

Primary External Interactions

• Employees (EE), Employers (ER), Claims specialist & other Stateside Teams on emails
• SME / Trainers at the client end for training.

Organizational RelationshipsReports To: Assistant Manager, Long Term Disability Process Supervises: 0SkillsTechnical Skills

• Good computer navigation skills
• Good keyboarding speed
• Good knowledge of complete MS Office suite

Process Specific Skills

• Knowledge about the Insurance industry in US
• Knowledge about US Culture
• Knowledge of Insurance principles

Soft skills (Minimum)

• Communication skills - should be able to read, interpret business documents. Good oral/written communication
• Proficiency in English - Spoken and Written
• Analytical and interpersonal skills
• Escalate issues if required
• Data gathering ability/ Eye for detail
• Team work/ Managing Self / Adaptability
• Ability to work successfully in production driven environment
• Adaptability to change
• Ability to work on routine/standardized transactions

Soft Skills (Desired)

• Self disciplined and result oriented
• Ability to multi task
• Ability to work effectively as part of a team
• Knowledge of Medical Terminology (preferred but not compulsory)

Education RequirementsGraduate with at least 15 years of education.Work Experience Requirements

• Minimum 1-2 years of experience in a transactional, blended process of insurance or related industry with relevant experience of working in a business environment (preferred but not compulsory)

MetLife