Description

Description and Requirements

Role Summary:
As part of Global Customer Services & Operations, the Complaints & Grievances Specialist plays a critical role in creating positive experiences for MetLife customers by investigating and resolving complaints related to Dental (including DHMO) claims. This role requires strong analytical skills, sound judgment, and exemplary customer service to ensure timely and compliant resolution of grievances, complaints, and regulatory inquiries.

Must be within a commutable distance of the Oriskany, NY, office location

In office once a month for meetings

Key Responsibilities:

Investigation & Resolution

• Conduct thorough investigations of complaints and grievances, including issues such as Quality of Care, Coverage Disputes, Access to Care, and State Complaints.
• Review and identify complaint issues in conjunction with insurance plan provisions and applicable regulations.
• Determine corrective actions and resolution decisions, including claim reprocessing and provider/member reimbursement when applicable.

Communication & Documentation

• Prepare comprehensive written responses addressing all concerns and corrective actions taken.
• Respond to telephonic inquiries from members and providers regarding complaint outcomes.

Collaboration

• Collaborate with internal partner areas such as Claims Operations, Legal, Compliance, Network Development, and SIU.
• Refer cases to Legal, Litigation, or SIU departments when necessary.

Compliance & Reporting

• Ensure all decisions and correspondence comply with plan contracts and state regulations.
• Maintain accurate and thorough complaint statistics for reporting and trending purposes.
• Monitor deadlines to meet time service standards and regulatory requirements.

Required Qualifications:

• Knowledge of claims process
• High School Diploma or equivalent.
• Strong verbal and written communication skills.
• Proven customer service and conflict resolution abilities.
• Analytical skills for interpreting, evaluating claims, and analyzing reports & data.

Preferred Qualifications:

• Minimum 5 years of experience in Dental.
• Knowledge of Dental terminology, procedures, and group plan contracts.

• Familiarity with systems such as NOVA, Dental SIR, MetCor, Insight platforms.
• Experience with MS Office (Excel, Powerpoint, CoPilot) a plus.
• Advanced knowledge of dental processes, procedure codes, and clinical terminology.
• Experience handling regulatory complaints.
• Ability to build relationships across departments and with external stakeholders.
• Sound business judgment and decision-making skills.

The expected salary range for this position is $53,000 - $70,700. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms.

Benefits We Offer

Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more!

About MetLife

Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces™, as well as the Fortune 100 Best Companies to Work For®, 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 individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!

MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics").

If you need an accommodation due to a disability, please email us at accommodations@metlife.com. 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.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.

$53,000 - $70,700


Requisition #: 14480

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