MetLife

Job Location: Virtual

Training Schedule: 5 - 6 weeks

Shift Details:  Friday - Tuesday schedule.  (working Saturdays and Sundays, off Wednesday & Thursday)

Home State P&C License required within 90 days of hire (supported by MetLife)

Start Date:  11/18/24

Role Value Proposition

 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.