Insurance Claims Specialist
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Valuable team member, the new Insurance Claims Specialist is responsible for gathering and processing the information required to complete the insurance claims process. Typical duties include determining covered insurance losses, documenting medical claims actions, and resolving claims through approval or denial of claims request. The position will report directly to the Claims Manager.
- Determines covered insurance losses by studying provisions of a policy
- Establishes proof of loss by studying documentation and assembling additional information from outside sources
- Documents specific claims by completing and recording forms, reports, logs, and records
- Analyzes insurance claims to prevent fraud
- Prepares reports by collecting, analysing, and summarizing information
- Resolves claims by approving or denying documentation, calculating benefits due, and determining compensation settlement
- Provide competitive market information.
- Simplify the current processes and increase efficiency
- Ensures legal compliance by following company policies, procedures, and guidelines, as well as state insurance regulations
- Maintains quality customer service by following customer services practices and responding to customer inquiries
- Protects operations by keeping claims information confidential
- Maintains a good relationship with insurance departments
- Accountability for Results – From previous and/or current experience can demonstrate personal responsibility for completing tasks within deadlines to a high standard and achieving quality results. Accepts responsibility for successes and failures and uses feedback to modify behaviour
- Customer Focus – Comes from an industry that holds the customer in the highest esteem, considers the customer perspective, and strives to find creative solutions that are in the best interest of the customer and the business. Works on tasks with customers in mind and follows up on customer needs, while also balancing the profitability metrics
- Job Knowledge – Demonstrate very good levels of relevant knowledge and skills to perform all aspects of the job. Acquires new knowledge and skills to continually improve performance.
- Business Knowledge – Be able to rapidly gain a strong knowledge of the company’s business, products, and governing regulations; stay current on trends and issues facing the company and marketplace
- Communication Skills - Demonstrates the ability to express thoughts and ideas clearly in both written and verbal format; solicits ideas and input from others; listens to diverging opinions.
- Execution - Demonstrates a sense of urgency to achieve results; acts decisively to prioritize workload, meet deadlines, and achieve deliverables
- Initiative - Demonstrates willingness to proactively address current and potential challenges and opportunities; willingly accepts increased responsibilities and seeks new opportunities to improve a task or process.
- Educated to Degree level or equivalent (Preferably - Medicine)
- Extensive knowledge of insurance related policies or legislations
- A minimum 3 years in a similar position in insurance industry
- Proficiency in English
- Strong computer skills in all MS packages
- Very good communication skills
- Very good time management and stress management of tight deadlines
- Attention to detail
- Ability to make good and fast decisions in a fast-paced environment
- Excellent conflict resolution skills
- Client orientation
- Friendly environment with multiple career development opportunities
- Inclusive and multicultural team where you can create impact with your innovative ideas and creative personality
- Various learning & development programs adapted to your needs and goals.
- Benefits (flexible hours, meal tickets, private medical subscription, insurance policy, Bookster subscription, discount on dental services, additional holiday based on seniority)
- Attractive salary and yearly additional compensation, according to your performance and support for the team.
- Good location – close to public transport stations (bus & subway) & remote working capabilities.
At Metropolitan Life, part of MetLife, Inc, one of the largest life insurance companies in the world, 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.
Metropolitan Life is an equal opportunity, affirmative action employer committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. It is Metropolitan’s Life policy to ensure equal employment opportunity without discrimination or harassment based on race, colour, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.