Job Location: Virtual - Must live within a commutable distance of the Tampa MetLife Office
Once a month in office for meetings - 1st Thursday of every month
Key Responsibilities
- Virtual role predominately work from a home office with required monthly visit to the assigned GCSO office
- Analyze and process claims in a productive environment through our TLC claim system
- Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and overpayments
- Review claims for receipt of all needed documentation and make outbound calls to providers for additional information
- Collaborate with our Claim Support Specialists, Customer Call Center, Plan of Care Team and Benefit Eligibility Coordinators to provide a seamless claims experience
- Abide by department guidelines and appropriately follow up on necessary tasks to process claims
- Meet quality review standards of processed claims
- Meet performance standards for financial accuracy, processing accuracy and claim timeliness
- Respond to insured inquiries regarding specific claim details via telephone conversations and/or written correspondence
- Gather and analyze information skillfully to identify and resolve problems in a timely manner
Essential Business Experience and Technical Skills
Required:
- Excellent analytical and mathematical skills
- Ability to pay attention to detail
- Ability to comprehend and apply varied rules to multiple policies
- Works well in a team environment
- Excellent organizational skills
- Proven ability to meet quality and time standards
- Basic knowledge of computer system, Microsoft Word, and Excel