Responsible for the processing of claims from start to finish using mainframe systems and PC based applications, ensuring all claims are received and processed on a timely basis
Accurate, detailed and timely identification, research, validation, and credit note issuance of various claims types, including detailed documentation packages supporting validated payment
Understanding contract language and independently interprets and applies contract language while validating claim
Works with multiple internal departments to acquire information, and approvals (such as customer service, distribution center, contracts, pricing, legal, etc.), as well as working with customers to acquire additional understanding and background on submitted claims
Keeping detailed status notes of ongoing research and providing status reports and reporting on metrics of claims, as well as providing customer metrics & contract performance insights based on claims payments
Maintaining an effective customer focus (both internal and external) by communicating with and providing supporting documentation for error resolution, efficiencies to reduce future errors, and collaborating with Accounts Receivable and Customer to resolve and collect on disputed balances
Actively participates in clearly defined assignments and projects as needed by management
Work independently, demonstrate ownership of assigned accounts, and manage prioritization of claims
Prepare for and participate in internal and external account meetings and status calls
Responsible for closely monitoring customer deductions, actively pursuing resolution/collection of deductions, and keeping status updates in deduction tracking tool
Communicates with Finance Shared Service regarding open deductions and status
Responsible for maintaining an effective customer focus: communicating with and providing supporting documentation for error resolution, efficiencies to reduce future errors, and collection of disputed balances
Responsible for internal reconciliation reporting and documentation of actions
Participate/contribute to special projects as needed.
Prepares for and participates in internal account meetings and internal status calls
Identifies significant issues to review with management and escalates issues and outstanding disputes to management if needed.
Requirements
Minimum:
Bachelor's degree with 1-4 years experience in financial analysis and customer payments, preferred.
Intermediate knowledge of mainframe systems.
Excellent written and oral communication skills to interact with all levels of internal and external customers.
Important competencies are teamwork, problem solving, innovation, planning and organizing, attention to detail, customer focus.
Advanced knowledge of Excel.
Preferred
Pharmaceutical industry experience preferable. Claims experience a plus.
Understanding of healthcare industry marketing and sales concepts and practices.
Values And Behaviors
Problem solving and decision making.
Analytical thinking, communication /teamwork, planning and organizing.
