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MetLife

Sells life insurance and workplace benefits

Medical Module Supervisor

Claims AdjudicationPosted on Nov 9
Full-timeMexico City, CDMX, MexicoNo salary listed

About the Job

Requirements

  • A medical degree and professional license are required.
  • At least 3 years of experience performing claims adjudication and managing personnel and resources.
  • Experience evaluating claims.
  • Ability to analyze and review determinations and claims processes, including reimbursement, scheduled surgery, or direct payment; knowledge of all three processes is desirable.
  • Ability to document cases.
  • Experience providing face-to-face service to insured members.
  • Knowledge of claims determinations and claims.
  • Ability to review endorsements, policies, and case files.
  • Ability to detect malpractice or improper practices.
  • Ability to control costs in catastrophic events.
  • Advanced Microsoft Office skills, including reports, pivot tables, database analysis, and projections.
  • Ability to work Sunday through Friday, 11:00 a.m. to 7:00 p.m., with Saturday off.
  • Ability to work at Hospital Ángeles Clínica Londres and periodically at Hospital Ángeles Roma.

Responsibilities

  • Adjudicate claims according to service levels, terms, endorsements, policies for each line of business, product characteristics, claims processes, regulations, controls, and strategic company projects.
  • Manage the assignment of cases according to committed response times, operational capacity, and operational needs.
  • Lead and design an operational strategy through effective administration of operational processes.
  • Create and manage inventories to meet area commitments and goals, considering personnel, material resources, and availability.
  • Supervise case responses, focusing on quality, clarity, timeliness, and customer satisfaction.
  • Manage conflicts and workloads in accordance with policies and regulatory guidelines.
  • Develop and ensure compliance with processes and service levels committed to customers and brokers.
  • Coordinate prioritization and urgent resolution of time-sensitive cases.

Desired Qualifications

  • Knowledge of all three claims processes: reimbursement, scheduled surgery, and direct payment.
  • Experience supervising personnel.
  • Ability to manage conflict and workloads.
  • Ability to prioritize and resolve urgent cases with a sense of urgency.
  • Adherence to policies and regulatory guidelines.
  • Basic knowledge of artificial intelligence.

About the Company

MetLife

Sells life insurance and workplace benefits

MetLife sells life, dental, disability and other insurance, along with annuities and retirement products, to individuals and to employers that offer them as workplace benefits. It is one of the largest US life insurers and a major supplier of group benefits to American employers, with insurance businesses across Asia, Latin America, Europe and the Middle East. Customers pay premiums for coverage, and MetLife invests those funds and also manages money for outside clients through its asset management arm. Its retirement business takes over pension obligations from employers and pays the monthly benefits owed to their retirees. MetLife was founded in 1868 and is based in New York City.

Company size
10,001+
Company stage
IPO
Headquarters
New York City, New York
Founded
1868

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