MetLife Pharma Sr Associate Vacancy – Candidates Apply Online
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 help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.
Job Title: Senior Associate
Position Summary: The primary function of the Nurse Reviewer is to evaluate individual Statement of Health applications for Life coverages for Group customers. 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 an is basis.
Education Bachelor in Pharmacy, Diploma in Pharmacy)
Experience
Preferred up to 12 months of work experience in a Hospital, BPO or Medical Transcription or medical underwriting process
Knowledge and skills (general and technical)
- Good computer navigation skills
- Working knowledge of MS Excel and MS Word.
- Keyboarding Skills not required as this is not a Data Entry Job.
- Knowledge about US Culture
- Judgment and decision making
- Knowledge of medical underwriting process
- Problem-solving skills
- Ability to multitask
- Knowledge of Medical Terminology
- Awareness of US insurance industry
Other Requirements (licenses, certifications, specialized training – if required)
· Diploma/Degree in pharmacy, Nursing.
Working Relationships
Internal Contacts (and purpose of relationship):
· Vinay Bisht – Assistant Manager: Reach out in case of any internal MetLife related query
External Contacts
(and purpose of relationship) – If Applicable
· Wes Vivyan – Stateside: Reach out in case of any process related query
Job Responsibilities
- Interpret customer Statement of Health provisions and process accordingly. Determine the insurability of the financial risk, based on the initial review of the Statement of Health, and all medical information provided.
- Evaluate Statement of health forms to identify situations requiring referral to Medical Underwriter.
- Review all appeals for requested coverage after the application was denied and the appeal received.
- Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction is met. While maintaining production and quality standards.
- Keep up to date on Statement of Health procedures by using the Institutional Statement of Health Library and attending required training.
- Identify and obtain missing information required to evaluate Statement of Health form from Web-based system, (SIR) and input missing information into Windows-based computer system, (StarTrack).
- Evaluate individual applications for group life and group disability coverage and make decisions regarding approval, denial, the need for further investigation in the form of medical records or exams.
- Mentor/Job Coach new Reviewers on Statement of Health procedures and workflow.
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