Pharma Claims Representative

Overview

Entry-level role processing international pharmacy insurance claims for members under direct supervision, with work allocated on a day-to-day or task-by-task basis.

What you'll do

• Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Monitor turnaround times to ensure claims are settled within required time scales, highlighting to your Supervisor when this is not achievable.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible.
• Interface effectively with internal and external customers to resolve customer issues.
• Identify potential process improvements and make recommendations to team senior.
• Actively support other team members and provide resource to enable all team goals to be achieved.
• Work across International business in line with service needs.
• Carry out other ad hoc tasks as required in meeting business needs.
• Work cohesively in a team environment.
• Adhere to policies and practices, training, and certification requirements.
• Examines and processes paper claims and/or electronic claims, completes data entry, maintains files, and provides support.

What you'll need

• Graduate (any) in medical, paramedical, pharmacy or nursing.
• Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims.
• Expertise in international insurance claims processing.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Good English language communication skills, both verbal and written.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Ability to meet/exceed targets and manage multiple priorities.
• Must possess excellent attention to detail, with a high level of accuracy.
• Strong interpersonal skills.
• Strong customer focus with ability to identify and solve problems.
• Ability to work under own initiative and proactive in recommending and implementing process improvements.
• Ability to organise, prioritise and manage workflow to meet individual and team requirements.

Nice to have

• Experience in medical administration, claims environment or Contact Centre environment.

Details

• Location: Bengaluru (Bangalore), India.
• Work timings: 7:30 am to 4:30 pm IST.