claims Specialist
claims Specialist
Posted on :
24-02-2024
Employer Active
1 Vacancy
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Job Description
Req ID : 2559572
Title: Drug Exception Specialist
Band: 4.1/4.2
Shift Timing: Shift D (1:30pm 10:00pm IST)
Team: H&D Claims
Role Summary:
Drug Exception Specialist Review High Cost Drug Claims and take decision to Approve or Decline member
request based on submitted medical reports.
Education/Experience
Minimum Graduate
12 years of in International BPOs (nonvoice)
Candidates to have worked in a previous North American/Canadian Insurance company with
Medical Claims knowledge/ experience.
BPharma will be good to have.
Good to have Drug knowledge (DIN Drug Identification Number Generic/ Brand Drug Drug
Formulary Salt Composition)
Good to have Knowledge on Medical Diagnosis (ICD9/10) Medical Terminology (e.g Biosimilar)
Good to have Knowledge on Drug Usage in Medical industry (Diabetes Migraine Weight loss
Arthritis)
Key Accountabilities:
Process claims on Complex Queues in a timely and accurate manner
Meets established quality control measures
Meets individual productivity requirements
Provides follow up on requests that cannot be immediately resolved
Escalates issues to management when needed
Works with management to set daily priorities to ensure prompt and efficient service
Maintains flexibility in a high speed demanding team environment
Identifies process improvements to increase efficiencies and streamline processes
Actively participates in departmental team meetings and other open forums
Assists with department projects and initiatives as needed
Soliciting and compiling information and data related to processing activities
Using PC application and functions such as Excel and Word to update and load data sets
Working with mainframe applications and Electronic Response Messaging
Creating and monitoring the processing checklists and calendars
Meeting and exceeding client defined service level metrics on timeliness and accuracy
Skill/Competencies:
Attention to detail.
Decision making based on available data
Work well within a team and as a selfmanaged member of a team
Excellent verbal and written communication
Able to manage multiple priorities and conflicting deadlines
Able to build strong bond with partners across business functions
Able to show problemsolving ability
Exhibit Client centric approach
Excellent organizational skills
Strong analytical skills and detail oriented
Works with people leader to clarify priorities and coordinates with others to get work done
Proactive and results focused
Flexible and able to set priorities to meet business goals
Good knowledge of Microsoft Office (Excel Word PowerPoint and others)
us healthcare,claims handling,drug cases,back office operations,international clients
Employment Type
Full Time
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