Receives requests by email and telephone regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
Receives requests by email and telephone regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
Support optimization of U.S. pharmacy products and services for international members, including benefit design opportunities, pharmacy utilization trends, specialty medication performance, affordability levers, and member/provider experience improvements.
Support optimization of U.S. pharmacy products and services for international members, including benefit design opportunities, pharmacy utilization trends, specialty medication performance, affordability levers, and member/provider experience improvements.
Design, develop, test, document and maintain reusable automation for infrastructure and operational services, including provisioning, configuration, patching, housekeeping and reporting.
Accountable to review, assess and predict inventory levels, call-inflow coordinating daily allocations and planning ahead to optimize staffing levels and to maximize operational results.
Lead the Regional Prepayment team who are responsible for identifying claims that should not be paid as received and identify claims with potential Fraud, Waste and Abuse savings to meet Provider Integrity targets and KPIs.