Senior Product Claims Assistant

Description and Requirements
Role Value Proposition
*This full-time position is to work both weekend days and have two weekdays off every week*
The Claims Coordinator accurately reviews medical records and invoices, utilizing their understanding of pet health diagnoses and procedures, to evaluate coverage and equitably settle pet health insurance claims with respect to policy limits & terms. Communicates with the Insured, Veterinarian or Pet Adoption Agency to determine the details of the claim, requesting and verifying necessary documentation, and informs the Insured of claim status or claim outcome. Utilizes the workflow queues to perform job functions to include, claim entry/policy association, pre-adjudication, Insured/Veterinarian documentation requests, claim closeouts, claim appeals, and "good to go" claims processing.
Key Responsibilities
Requests and communicates with Insureds, Veterinarians, or Adoption Agencies for clarification of diagnosis/additional information necessary to accurately process claim.
Adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. Follows adjudication policies and procedures to ensure proper payment of claims.
Documents phone calls in system and follows up on issues if needed.
Resolves problems resulting from claim adjudication and communicates claim status and claim outcome with Insureds.
Prepares reports as required by management and enters/receives inbound documents as assigned.
Essential Business Experience and Technical Skills:
Required:
High school diploma or equivalency
Three years veterinary medical experience or equivalency preferred.
Strong understanding of veterinary medical terminology
Proven history of adherence to corporate policies, procedures, and guidelines
Proven Attendance Reliability
Excellent tracking, follow-up, and relationship building skills.
Preferred:
Vet Tech License
Ability to operate in a fast-pace, multi-tasking environment with deadlines.
Strong written, verbal, interpersonal, and phone communication skills
Articulate, professional, and possesses a strong quality customer service mindset with attention to detail.
Strong computer background using MS Word, Outlook, Excel, and Internet
Ability to learn quickly (to include our proprietary CRM system for managing customers)
Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials.
At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers.
The expected salary range for this position is 41,600-50,900. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.
Benefits We Offer
Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces™, as well as the Fortune 100 Best Companies to Work For®, 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.
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!
MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics").
If you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.
41,600-50,900