Location
Bangalore | India
Job description
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
- 1-2 years of in International BPOs (non-voice)
- 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 self-managed 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 problem-solving 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
- Pro-active and results focused
- Flexible and able to set priorities to meet business goals
- Good knowledge of Microsoft Office (Excel, Word, PowerPoint and others)
Skills: us healthcare,claims handling,drug cases,back office operations,international clients
Job tags
Salary
