Team Leader - Operations

MetLife; Dadri; On-site; INR 350,000 - 700,000; Full time

Job summary

MetLife is seeking an ADA Specialist/ADA Consultant to partner with employees and employers to gather and validate accommodation needs. You will assess medical necessity, explore options and costs, and manage documentation.

The role involves absence management, adjudication on federal/state leaves, and interaction with claim teams to ensure timely, compliant processing.

Qualifications

• Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.
• Minimum 3-4 years of experience in customer service background of insurance or related industry.
• Experience in handling insurance processes is preferred but not mandatory.

Responsibilities

• Administer ADA standalone claims and determine eligibility.
• Complete eligibility decisions and gather required data from employees, physicians, or employers.
• Review new ADA requests, evaluate against leave plans, and make initial claim decisions.

Skills

Computer navigation

Keyboarding speed

MS Office

Education

Bachelor’s degree / Diploma (minimum 15 years education)

Tools

MS Office Suite

Job description

Position Summary

ADA Specialists/ ADA Consultant partner with the employee and employer to gather and communicate the facts about the accommodation need/request, substantiate the medical need for an accommodation, evaluate accommodation options/costs (including alternative options), & manage documentation and supporting material.

Job Responsibilities

Basic Function

• Administer ADA (Americans with Disability Act) standalone claims


• Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems.


• Promptly review new ADA, evaluate against appropriate leave plans and make initial claim decision.


• Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc.


• Update systems to accurately reflect leave status and ensure appropriate diary documentation exists


• Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures


• The position is expected to do absence management and adjudication on Federal, State and company leaves.


• Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician’s office

Essential Functions

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)


• Analyze and research all discrepancies


• Research & Investigate and resolve outstanding items


• Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals


• Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls


• Establish action plans for each file to bring claims to resolution


• Utilize internal and external specialty resources to maximize impact on each claim file


• Use PC programs to increase productivity and performance


• Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards


• Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence


• Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and meeting key measures


• Ensure adherence to established attendance schedules


• Close visual activity - viewing a computer terminal and extensive reading

Any other essential function that may occur from time to time as directed by the Supervisor.

Primary Internal Interactions

• UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support


• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance


• Subject Matter Expert for the purpose of work thread related issues and escalated transactions


• QCA for the purpose of feedback and internal Performance Guarantee quality audit team


• Trainers for the purpose of Pre-process and Process DCA training


• Disability Customer Advocates for escalation resolution

Primary External Interactions

• End customer to be contacted through emails/calls for information gathering/decision update


• Claims specialist & other Stateside Teams on emails/calls


• SME / Trainers at the client end for training

Education, Technical Skills & Other Critical Requirement

Education

Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.

Experience

(In Years)

Minimum 3-4 years of experience in customer service background of insurance or related industry with relevant experience of working in a business environment (preferred but not compulsory)

Technical Skills

• Good computer navigation skills


• Good keyboarding speed


• Good knowledge of complete MS Office suite

Process Specific Skills

• Knowledge about the Insurance industry in US


• Knowledge about US Culture


• Knowledge of Insurance principles