Prior Authorization Associate - Inbound US Healthcare
NTT Data Services Philippines, Inc.
Quezon City, PH
6d ago
source : Bossjob

Responsibilities :

  • Handle inbound provider calls for health insurance companies (based in US) for customer medical membership on High Deductible, EPO, PPO, HRA, and Idemnity plans for benefit verification / eligibility, claim status and general queries.
  • Answer calls and document as per customer's written specifications in accordance to the process and procedure document.
  • Ensuring timely and accurate completion of transactions to meet or exceed client SLAs.
  • Responding to customer request via phone and / or writing to ensure timely resolution of unpaid medical insurance claims.
  • Analyzing medical insurance claims for quality resolution.
  • resolving complex situations following pre-established guidelines.
  • developing and maintaining a solid knowledge of healthcare insurance industry and of all products, services and processes performed by the team.
  • Organizing and completing tasks according to assigned priorities.
  • Skills :

  • 1+ years of experience in global call center, where you had to correspond in writing or over the phone with customer or business associates who spoke English.
  • 6+ months US Health Insurance inbound call center experience handling prior authorization
  • 1+ yr(s) experience of using a computer with Windows PC applications that requires use of keyboard, navigation screens and learn new software tools.
  • 1+ yr(s) experience in service-oriented role where you had to apply business rules to varying fact situations and making appropriate decisions.
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