Non Voice Transaction Processing New Associate - Health Account (Jul 2022)

Main Responsibilities

• Analyze claims as appropriate for e.g. pay, pend or deny.
• Adjudicate claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor turnaround times to ensure claims are settled within required time scales, highlighting when this is not achievable.
• Monitor and highlight high cost claims and ensure relevant parties are aware.
• Interface effectively with internal and external customers to resolve customer issues.
• Actively support all team members and provide resource to enable all operational goals to be achieved
• Meet or exceed Service level agreement requirements. Minimally set at a 7 day turnaround for claims or in accordance with client specific requirements. This number will be reviewed periodically and can be increased or decreased based on business need.
• Good understanding of international healthcare product and plan design.