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Job Summary: This role is responsible for adjudicating claims, managing operations, ensuring process compliance, and customer satisfaction in hospital insurance. Key Highlights: 1. Lead the operational strategy and administration of hospital processes. 2. Ensure compliance with service levels and customer satisfaction. 3. Manage the assignment of procedures and ensure expense control. ### **General Information** **Location** Mexico City, Ciudad de Mexico Working Schedule Full\-Time Work Arrangement In Office Travel Required 10% Relocation Assistance Available No Posted Date 30\-Apr\-2026 Job ID 17323 ### **Description and Requirements** We are global experts and recognized leaders in insurance. With over 150 years of experience, we deliver best-in-class life insurance, annuities, and benefits programs to more than 90 million customers across 50 countries. In Mexico, we are the #1 individual insurer in the country, serving over 10 million insured individuals. We are seeking: **Hospital Module Manager** **Purpose or Mission of the Role:** Adjudicate incoming claims according to service levels, policy terms, endorsements, and business-line-specific policies—based on product features, claims processes, regulations, controls, and the company’s strategic initiatives. **Key Responsibilities** * Design an operational strategy through proper administration of operational processes. * Ensure compliance with agreed-upon processes and service levels for customers and brokers. * Respond to procedures guided by three core principles: quality, clarity, timeliness, and customer satisfaction. * Manage procedure assignments according to committed response times, installed capacity, and operational needs. * Results-oriented approach aligned with organizational guidelines and regulations. * Manage inventories to meet departmental commitments and goals, considering staffing, material resources, and availability. **Requirements and Qualifications** * Bachelor’s degree in Medicine (degree and professional license required). * Experience in insurance. * Minimum 3 years of experience in roles similar to this position. * Intermediate English proficiency. * Claims adjudication experience. * Analysis and review of adjudications and processes (reimbursement, scheduled surgery, or direct payment); knowledge of all three processes is desirable. * Case documentation. * Familiarity with adjudications and claims. * Review of endorsements, policies, and case files. * Detection of improper practices. * Cost containment during catastrophic events. * Advanced Microsoft Office skills (reports, pivot tables, database analysis, and forecasting). **Specific Requirements for Internal Candidates:** * You must have held your current position for at least 12 months. * Your most recent performance evaluation rating must be Satisfactory. * Your manager must be informed prior to your application. * We will require a confirmation email from your manager. * We recommend against applying to two or more processes simultaneously. **Interpersonal Profile** * Customer focus, teamwork, and planning/organization of activities. * Effective communication with peers, proactivity, analytical ability, and problem-solving skills. * Motivation and commitment to the adjudication area. * Ability to work under pressure and interest in medical-administrative tasks. Location: Médica Sur Hospital Schedule: Monday to Saturday, 11:00 a.m. to 7:00 p.m. Work Model: On-site Employment Type: Permanent *At MetLife, we are committed to fostering diversity among employees through non-discriminatory treatment based on race, gender expression/identity, sexual orientation, religion, age, nationality, marital status, disability, physical or economic condition. HIV and pregnancy testing are not required for hiring, retention, or promotion, and equal employment opportunities are ensured.* We share the link to our Candidate Publication and Application Guidelines. **Benefits We Offer** Our benefits are designed to support holistic well-being, including programs for physical and mental health, financial wellness, and family support. We offer major medical expense insurance, life insurance, and a competitive compensation package—including performance bonuses, a savings fund, and a pension plan. We also provide expanded parental and adoption leave, plus additional benefits such as volunteer time off, birthday leave, Cultural Heritage Day, cultural and sports events—and much more! **About MetLife** Recognized on Fortune’s 2025 “World’s Most Admired Companies” list and Fortune’s 2025 “100 Best Companies to Work For™” list globally, 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. Our purpose is simple: to help our colleagues, customers, communities, and the world at large build a safer future. United by purpose and guided by our core values—Win Together, Do the Right Thing, Deliver Impact, and Think Forward—we are inspired to transform the next century of financial services. At MetLife, it’s \#AllTogetherPossible—join us! At MetLife, we are committed to fostering diversity among employees, through non\-discriminatory treatment for reasons of gender, gender expression, sexual orientation, religion, age, nationality, marital status, disability, physical or economic condition, HIV and embarrassment as a requirement for entry, permanence or ascension and there is equal employment opportunities.
