Claims Coordinator

Description

Position Summary: We are seeking a Medical Case Management Coordinator to support the team in achieving organizational objectives, ensuring timely handling of customer requests, and responding to claims. Key Highlights: 1. Leadership and development of medical and administrative teams 2. Productivity management and SLA compliance 3. Quality control and risk management in medical records City/Cities Mexico City Country Mexico Working Schedule Full\-Time Work Arrangement Hybrid Relocation Assistance Available No Posted Date 10\-Mar\-2026 Job ID 15403 ### **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, with over 10 million insured individuals.* We are seeking a **Medical Case Management Coordinator.** **PURPOSE OR MISSION OF THE ROLE**: Support your team in achieving organizational objectives, ensure customer requests are handled in strict adherence to established procedures and policies, guaranteeing customer satisfaction in responding to claims. **PRIMARY RESPONSIBILITIES** * **Leadership and Team Development**: Direct supervision of medical and administrative staff, including coaching, clinical training, and workload management to ensure compliance with corporate protocols. * **Productivity and SLA Management**: Real-time monitoring of key performance indicators (response times, case volume, documentation efficiency) and design of strategies to prevent delays in daily operations. * **Quality Control and Risk Management**: Audit of medical records and clinical notes to proactively identify errors, applying root cause analysis ($RCA$) and corrective action plans ($CAPA$). * **Cost Containment and Strategy**: Optimization of operational workflows and medically informed decisions that positively impact claim frequency, proposing innovations and process automation. * **High-Level Stakeholder Relations**: Direct intervention in critical or high-financial-impact cases, and serving as the technical liaison with VIP clients, brokers, and internal departments (Medical Networks, Direct Payment). * **Executive Communication**: Preparation and presentation of performance reports, metric dashboards, and strategic proposals to senior leadership. **REQUIREMENTS AND QUALIFICATIONS** * **Bachelor’s Degree in Medicine (degree and license) – Mandatory.** * Minimum 5 years of experience in insurance, with involvement across various areas of Claims Adjudication (Direct Payment, Reimbursement, Scheduled Surgery, and/or Specialized Medical Management). * Minimum 1 year of experience in GMM Claims Coordination and personnel management. * Personnel management (onboarding, offboarding, productivity and quality compliance). * Ensuring SLA compliance. * Development of KPIs to measure the impact of such improvements (Before/After). * Supervision of documentation quality, clinical notes, justifications, and medical supporting documents generated by the team. * Design of continuous improvement strategies. * Communication with internal and external customers. * Office: Advanced reporting (pivot tables and analytical procedures) * PowerPoint (preparation of executive presentations). **INTERPERSONAL PROFILE** * Leadership * Teamwork * Planning and organization of activities * Effective communication (with peers and other Claims areas), Proactivity * Comprehensive analysis * Problem solving * Identification of root causes in key Claims opportunity areas * Commitment * Motivation Leader: Patricia Medina Area: Operations \- Claims Schedule: Monday to Thursday 8:00 am to 5:30 pm, Friday 8:00 am to 3:30 pm. Work Type: Hybrid Location: Torre Manacar. *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 exist.* **Benefits We Offer** Our benefits are designed to holistically support your well-being, with programs covering physical and mental health, financial wellness, and family support. We offer major medical expense insurance, life insurance, combined with a competitive compensation package including performance bonuses, savings fund, and pension plan. We also provide extended 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 magazine’s 2025 “World’s Most Admired Companies” list and Fortune’s 2025 “100 Best Companies to Work For™” list worldwide, 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 more secure future. United by purpose and guided by our core values — Win Together, Do the Right Thing, Deliver Impact over Activity, 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.