Life Claims Consultant

Description and Requirements
Job Description - Life Statement of Health
Position Title: Associate/Sr. Associate (R3 & APSQ)
Function, Responsibility Level:
Operations, Specialist
Reports to (Responsibility Level): TL / AM / UM
Supervises: NA
Location: Jaipur
Global Grade:
9
Cost Center:
10020441
Complexity:
T5C3 -
PID/s Load Mapping:
INS-002
Position Summary
Basic Function
The primary function of the Nurse Reviewer is to evaluate Statement of Health applications for Life coverages for Group customer. Also determine the need for additional medical information and decision making regarding the insurability of an applicant based on MetLife's Medical Underwriting Guidelines. Provide guidance to SOH Reviewer 1 & 2 on need basis.
The key deliverables of the role will include but will not be restricted to the details below:

• Review customer Statement of Health form and make decisions regarding approval, denial, the need for further investigation in the form of medical records or exams
• Understand the US medical underwriting guidelines and navigate for relevant actions to be taken while initiating the final decision basis received medical records from physician (APSQ and APS)
• Review medical condition report (Paramed & Exam- Blood & Urine Report) and validate the suggested medical treatment/medication
• Understand the conditions for the prescribed medicines by physician
• Identify and obtain missing information required to process approve & decline condition
• Review Statement of Health procedures by using the defined SOP
• Ensure that the allocated reports/certification requests are completed within recommended timelines and accuracy thresholds Adhere to agreed timelines and SLA's

Knowledge, Skills and Abilities
Education

• Graduation or Diploma in Bio-Sciences (Bachelor in Pharmacy, Degree in Biotechnology, Degree in Biochemistry / Microbiology / Nursing, Diploma in Pharmacy)

Experience

• Professional with 3-4 years of work experience in BPO industry preferably under medical transcription and medical summarization for US Insurance

Knowledge and skills (general and technical)

• Excellent Knowledge of Medical Terminology & medicines
• Computer navigation skills
• Basic knowledge of MS Office
• Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)
• Exposure to multiple mainframe and web systems
• Good analytical skills with an ability to research & take decision to resolve problems in underwriting
• Knowledge of Insurance principles in relation to the US Insurance industry
• Knowledge about US Culture
• Strong organizational skills
• Good communication skills both written & Verbal
• Demonstrate ability to work independently and in a team environment
• Self-disciplined and results oriented
• Ability to multitask
• English language skill - should be able to read, comprehend and write correctly
• Must be opened to working in shifts

Other Requirements (licenses, certifications, specialized training - if required)

• Diploma/Degree in pharmacy

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.

Enclosures:
MetLife Values:
Our purpose and values
Our purpose is why we are in business and reflects what we stand for and believe in. Our purpose is to help people pursue more from life . Our values are how we achieve that purpose, through an expression of who we are, what we stand for as a company and how we conduct our business :
Put Customers First
Caring for and respecting customers is core to everything we do. It defines our work and shapes the culture for our people, radiating out to our shareholders and communities.
Be The Best
We are relentless in our search for new and better ways of doing things. As a leader in our industry, we constantly raise the bar, take calculated risks and learn quickly from our mistakes.
Make Things Easier
Products in our industry aren't always easy to understand. That's why we are always looking for simpler ways to connect customers to the best solutions. By doing this, we aim to exceed their expectations and build trust.
Succeed Together
United by our purpose, we live by a collective commitment to honesty, integrity and diversity. We are open and inclusive, proudly taking and applying the best ideas from every part of our company.
#BI-Hybrid