Description and Requirements

• Scrutinizing dental claim documents & settlements
• Process claims as per the set healthcare guidelines
• Respond to customer requests via multiple sources, providing excellent service to MetLife's customers who have insurance or other financial service products or benefit plans.
• Research requests regarding various product aspects, policy provisions, claim status, basic procedures, etc.
• 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
• Efficiently access and navigate multiple electronic systems to provide a complete and integrated response to the customer's inquiry.
• Handle escalations
• Need to ensure quality and productivity targets are met
• Ensure compliance with internal policies and procedures, external regulations and information security standards

Knowledge, Skills and Abilities

Education

• Bachelor's degree (B.com,BBA,BA,BSC) or diploma with a minimum of 15 years of education except specialized skills like BCA ,BTech ,Medical Graduates etc.

Experience

• 2 years of work experience

Knowledge and skills (general and technical)

Technical Skills

• Computer navigation skills
• Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)
• Working knowledge of MS Excel and MS Word.
• Process Specific Skills
• Knowledge of Insurance principles in relation to the US Insurance industry
• Knowledge about US Culture

• Knowledge of Dental claims terminologies and processes will be an added advantage
• Written- External/Internal (Free Flow) Email Writing
• Free flow correspondence creation
• Excellent comprehension skills - Interpret/analyze data from various resources , understands , documents and responds appropriately

Soft Skills

• Strong organizational skills
• Excellent Language skills (written ,verbal and comprehension)
• Demonstrate ability to work independently and in a team environment
• Self-disciplined and results oriented
• Ability to multi task
• Strong understanding and comprehension of the English language
• Good PC skills
• Attention to detail
• Team player
• Positive attitude

Working Relationships

Internal Contacts

(And purpose of relationship):

• AM/TL for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support as well as associate development.
• Manager for the purpose of settling issues left unresolved by the AM/TL and monthly evaluation of performance.
• Quality Compliance Analyst (QCA) for the purpose of feedback and audit.
• Trainers for the purpose of pre-process and process training.

External Contacts

(And purpose of relationship) - If Applicable

• MetLife Subject Matter Experts for the purpose of seeking missing information.
• MetLife Subject Matter Expert for the purpose of work-related issues and escalated transactions.

About MetLife

Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™, MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.

As part of our New Frontier strategy, MetLife is building an AI-enabled, people-centered future. We're looking for people who bring curiosity, adaptability, and a growth mindset as we use AI to enhance how we serve customers, support communities, and evolve the way work gets done. At MetLife, AI is a responsible partner that supports human judgment, creativity, and continuous improvement while helping us build trust, inclusion, and long-term value.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!