Job Description
Job Location: Virtual but required to be in-office at least one time a month, if commutable to an office, as required by the business.
Start date: 1/26/26
Training: approximately 6-7 weeks, Monday - Friday, 8 - 4:30pm EST
Schedule once training concludes: This role works EVERY Saturday & Sunday. New Hires will have either Monday & Tuesday off OR Thursday & Friday off.
New hires will establish a start time between 7-10am EST, working 8 hours + 1/2 hour lunch
Holidays are staffed based on preestablished schedule or on a volunteer basis.
P&C License required within 3 months of hire.
Role Value Proposition
The Claims Coordinator accurately reviews medical records and invoices, utilizing their understanding of pet health diagnoses and procedures, to evaluate coverage and equitably settle pet health insurance claims with respect to policy limits & terms. Communicates with the Insured, Veterinarian or Pet Adoption Agency to determine the details of the claim, requesting and verifying necessary documentation, and informs the Insured of claim status or claim outcome. Utilizes the workflow queues to perform job functions to include, claim entry/policy association, pre-adjudication, Insured/Veterinarian documentation requests, claim closeouts, claim appeals, and "good to go" claims processing.
Key Responsibilities
- Requests and communicates with Insureds, Veterinarians, or Adoption Agencies for clarification of diagnosis/additional information necessary to accurately process claim.
- Adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. Follows adjudication policies and procedures to ensure proper payment of claims.
- Documents phone calls in system and follows up on issues if needed.
- Resolves problems resulting from claim adjudication and communicates claim status and claim outcome with Insureds.
- Prepares reports as required by management and enters/receives inbound documents as assigned.
Essential Business Experience and Technical Skills
Required:
High school diploma or equivalency
Three years veterinary medical experience or equivalency preferred.
Strong understanding of veterinary medical terminology
Proven history of adherence to corporate policies, procedures, and guidelines
Proven Attendance Reliability
Excellent tracking, follow-up, and relationship building skills.
Ability to obtain P&C License during training as a condition of employment. (new hire will have three months and three tries to successfully obtain the license.)
Preferred:
Vet Tech License
Ability to operate in a fast-pace, multi-tasking environment with deadlines.
Strong written, verbal, interpersonal, and phone communication skills
Articulate, professional, and possesses a strong quality customer service mindset with attention to detail.
Strong computer background using MS Word, Outlook, Excel, and Internet
Ability to learn quickly (to include our proprietary CRM system for managing customers)
Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials.
Equal Employment Opportunity/Disability/Veterans
If you need an accommodation due to a disability, please email us at
[email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
Job Tags
Work at office, Monday to Friday, Weekend work,