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Metlife
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Specialist

Specialist

Metlife

3 - 10 years

5 - 12 Lacs

Noida

Posted:4 hours ago| Platform:

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Skills Required

Supervisor Basic Usage Claims Compliance Process excellence Workflow Research Management

Work Mode

Work from Office

Job Type

Full Time

Job Description

Basic Function

Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and

state regulatory and/or company plan requirements and established FMLA workflow procedures

Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee,

physicians office or employer through outgoing calls, email, fax or other supporting systems.

Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans

and make initial claim decision.

Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW

confirmation, return phone calls, etc.

Update systems to accurately reflect leave status and ensure appropriate diary documentation exists

Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures

The position is expected to do absence management and adjudication on Federal, State and company leaves.

Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees,

employers/customer and physician s office

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, entitlement and applicable plan provisions while meeting timeliness goals

Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside

resources by email and outgoing calls

Establish action plans for each file to bring claims to resolution

Utilize internal and external specialty resources to maximize impact on each claim file

Use PC programs to increase productivity and performance

Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee 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

Close visual activity - viewing a computer terminal and extensive reading

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

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