Specialist

Basic Function

The primary function of the Nurse Reviewer is to evaluate Statement of Health applications for Life coverages for Group customer. 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 need basis.

The key deliverables of the role will include but will not be restricted to the details below:

·Review customer Statement of Health form and make decisions regarding approval, denial, the need for further investigation in the form of medical records or exams

·Understand the US medical underwriting guidelines and navigate for relevant actions to be taken while initiating the final decision basis received medical records from physician (APSQ and APS)

·Review medical condition report (Paramed & Exam- Blood & Urine Report) and validate the suggested medical treatment/medication

·Understand the conditions for the prescribed medicines by physician

·Identify and obtain missing information required to process approve & decline condition

·Review Statement of Health procedures by using the defined SOP

·Adhere to agreed timelines and SLA’s

Knowledge, Skills and Abilities

Education

·Graduation or Diploma in Bio-Sciences (Bachelor in Pharmacy, Degree in Biotechnology, Degree in Biochemistry / Microbiology / Nursing, Diploma in Pharmacy)

·Professional with 3-4 years of work experience in BPO industry preferably under medical transcription and medical summarization for US Insurance

Knowledge and skills (general and technical)

·Excellent Knowledge of Medical Terminology & medicines

·Computer navigation skills

·Basic knowledge of MS Office

·Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)

·Exposure to multiple mainframe and web systems 

• Good analytical skills with an ability to research & take decision to resolve problems in underwriting

·Knowledge of Insurance principles in relation to the US Insurance industry

·Knowledge about US Culture

·Strong organizational skills

·Good communication skills both written & Verbal 

·Demonstrate ability to work independently and in a team environment

·Self-disciplined and results oriented

·Ability to multitask

·English language skill – should be able to read, comprehend and write correctly 

·Must be opened to working in shifts 

·Diploma/Degree in pharmacy

Working Relationships

• AM/TL for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support as well as associate development.
• Manager for the purpose of settling issues left unresolved by the AM/TL and monthly evaluation of performance.
• Quality Compliance Analyst (QCA) for the purpose of feedback and audit.
• Trainers for the purpose of pre-process and process training.

External Contacts 

(And purpose of relationship) – If Applicable

·MetLife Subject Matter Experts for the purpose of seeking missing information.

·MetLife Subject Matter Expert for the purpose of work-related issues and escalated transactions.