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 your 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.
Requirements*:
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.
Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential.
