Utilities Engineer

2 weeks ago


Cairo, Cairo, Egypt Viatris Full time

ON-SITE

Job Overview

The Claims Resolution Specialist helps in resolving provider claims payment status concerns, provider payment disputes, eligibility, and authorization verification. The role involves ensuring compliance with regulations, company policies, and Customer Service procedures.

Key Responsibilities

  • Assist providers with inquiries related to enrollment, claims submission, payment, benefit interpretation, and referrals for medical care.
  • Verify member eligibility, claims, and authorization status for providers.
  • Thoroughly follow up and address all provider inquiries and requests.
  • Contact Health Networks, providers, and collection agencies when necessary to resolve claims billing and payment disputes.
  • Support providers with Web Portal registration and technical assistance.
  • Efficiently handle a high call volume in a call center while meeting quality standards.
  • Document all issues, complaints, and grievances accurately in the system.
  • Escalate calls as needed.
  • Adhere to company policies and procedures.

Skills Needed

  • Meet quality and production standards.
  • Work independently and collaboratively.
  • Build effective relationships with staff and providers.
  • Manage multiple tasks and deadlines.
  • Maintain professionalism in a fast-paced environment.
  • Learn and apply regulations related to member eligibility.
  • Follow instructions effectively.
  • Communicate clearly and concisely.
  • Utilize computer and software effectively.

Requirements

  • High School diploma or equivalent.
  • At least 1 year of experience in call center or customer service dealing with provider claims issues.
  • Minimum 2 years of claims experience.

Preferred Qualifications

  • Experience with HMO, Medicare, Medicaid, or Health Services.

Knowledge of

  • Managed health care principles and practices.
  • Handling provider customer service issues.
  • Medical coding and billing systems.
  • Insurance claim forms and pricing methodologies.
  • Benefit interpretation and administration.

Benefits

At Sunshine Enterprise USA LLC, we value our employees and provide competitive pay, health benefits, 401(k) plan, recognition programs, and more. Benefit eligibility is based on employment status.

Sunshine Enterprise USA is an Equal Opportunity Employer.



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