• Review and process claims submissions
• Clarify any missing account information and update records accordingly
• Answer a high volume of calls promptly
• Screen and direct calls accordingly
• Maintain quality standards and validate data provided
• Respond to phone call inquiries regarding the processing of a claim
• Manage time adequately to ensure proper turnaround for all tasks such as customer service requests, follow-up, and audit feedback
• Work with teammates and supervisor to ensure the needs of the client are being met
• Comply with state laws, policy and company procedures
• Utilize specified phone call production tracking and reporting procedure
• Adhere to strict attendance and tardiness policies

Skills: Claims Processing, Data Management, Customer Service, Call Screening and Direction, Quality Assurance, Problem Solving, Time Management, Team Collaboration

• Prepare and submit of EU VAT Reclaims in line with country rules and regulations.
• Ensuring all Claim Documentation is requested from both clients and VAT offices.
• Filing and storing of Claim Documents in line with company policy.
• Dealing with VAT offices in relation to queries, rejections, appeals and any other issues that may arise.
• Assessing Pending VAT to identify claims that meet quarterly and yearly VAT thresholds.
• Dealing with queries/questions from both internal and external bodies.
• Interact with other colleagues/departments with regards to projects, new clients and general communications.
• Ensure that weekly/monthly/quarterly targets are met.
• Dealing with Supplier issues to insure that all invoices are issues in line with VAT office rules and regulations,
• Supporting all departments by providing VAT updates and raising issues that arise from claim rejections.

Skills: EU VAT Regulations Knowledge, Documentation Management, Communication Skills, Problem Solving, Customer Service Orientation, Collaboration, Target Achievement, Supplier Management

• Attending and successfully completing the trainings scheduled by the client and employer
• Processing assigned claims based on client specified guidelines or as directed by team lead
• Meeting claims productivity targets of claims per hour or day as set by team lead
• Collaborate with other team members on special projects by the team leads including process documentation, training, quality audit, assisting with surge activity for client or any other project as determined by the team lead
• Develop Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10, UB04, CMS 1500, authorization and other terms, terminology and concepts of healthcare
• Develop some level of communication with client Claims managers to address issues, concerns and take preventive measures to avoid service quality issues
• Reporting shift timings etc. with the prime objective of meeting and exceeding customer deliverables
• Participate in meetings and project activities outside of the primary location at locations determined by UST management team and team lead
• Determine if claim information is complete and correct
• Enter/verify claims data.
• Resolve claim edits, review history records and determine benefit eligibility for service. 
• Review payment levels to arrive at final payment determination.

Skills: Claims Processing Efficiency, Healthcare Terminology and Coding, Attention to Detail, Collaboration and Teamwork, Client Communication, Meeting Deadlines, Adaptability and Flexibility, Data Entry and Verification

• Processes new claims or modifies existing claims according to the appropriate agency and/or action
• Documents and updates internal database based on daily contact of select members of assigned applicant group and application evidence requirements
• Ensures that internal database has appropriate information in the correct fields, such as work activity, medical conditions, third party contact information, employment and salary information
• Identifies and takes appropriate actions to complete and submit required financial, medical and personal information forms to support the client application process.
• Reviews outgoing client material for accuracy prior to submittal.
• Complies with ethics, privacy and compliance policies and procedures
• Responsible for mail correspondence and logging important information and documents
• Meets all production and quality standards. 
• Attends all required training classes.
• Elevates issues to next level of supervision
• Maintains accurate records, including timekeeping records.

Skills: Claims Processing, Database Management, Documentation Accuracy, Form Completion, Compliance Adherence, Communication and Correspondence, Quality Assurance, Training and Development

• Embody, support, promote, and enhance the team corporate culture
• Strive to exceed established daily productivity, scheduled adherence, and quality standards
• Processes claims according to specified procedures and standards, meeting all position production and quality metrics
• Cross train team members to ensure business continuity and adhere to a “three-deep” cross training philosophy
• Provide solutions and improve efficiency by thinking analytically and being solution orientated
• Review participant requests and enter information into the software system daily
• Review electronic transactions and request appropriate documentation
• Enter participant demographic and benefit election information into the software system
• Initiate activation of electronic payment mechanisms
• Review and send client reports and participant statements

Skills: Team Collaboration and Culture Enhancement, Productivity and Quality Standards, Claims Processing Expertise, Cross-Training and Business Continuity, Analytical Thinking and Problem-Solving, Data Entry and Management, Benefit Administration, Client Communication and Reporting

• Meets or exceeds all department standards such as productivity, quality and attendance
• Responsible for claims editing on claims due to data entry errors in core processing system as well as in the data entry vendors queue
• Responsible for processing various Data Integrity reports in accordance with department policies and procedures. 
• Processes member reimbursement requests Claims data entry and processing tasks
• Evaluation and resolution of Customer Service cases related to reimbursement requests.
• Review and validation of requests for claim review and other claims documents. 
• Demonstrate solid judgment and discretion working with confidential information.
• Comply with all department and company guidelines including all applicable laws and regulations.
• Seeks assistance from Team Subject Matter Experts (SMEs)
• Ensure the accuracy of adjudicating claims and to develop individual skills and grow professionally.
• Work with teams inside and outside the department and external customers

Skills: Claims Processing and Editing, Data Integrity and Reporting, Customer Service Resolution, Confidentiality and Discretion, Compliance Adherence, Collaboration and Teamwork, Professional Development, Quality and Productivity

• Experience in a claims/customer service healthcare environment
• Experience with internal applications, such as Diamond, Macess, and HealthEdge preferred. 
• Understanding of managed care concepts and a strong understanding of CPT, ICD-10), HCPCS coding guidelines and CMS1500 & UB04 billing forms preferred. 
• Problem-solving and analytical skills with the ability to multi-task. 
• Able to work independently and as a part of a team. 
• Ability to effectively communicate to partner departments. 
• Knowledge of Microsoft Office applications and internet navigation
• Experience in a warehouse/cross-dock environment
• Able to communicate effectively and professionally verbally and in writing
• Proficiency with MS Excel and Word
• Able to work scheduled hours

Qualifications: BA in Health Information Management with 4 years of Experience

• Strong communication skills, including written and verbal
• Strong foreign Languages (strongly preferred (i.e. Spanish, Chinese, Russian, Turkish, Urdu, Hindi, etc.))
• Knowledge of Auto Property Damage Claims (preferred)
• Experience in Insurance claims  or as an adjuster
• Advanced skills in Excel and Microsoft Office products
• Excellent verbal, written and interpersonal communications skills
• Problem-Solving Skills/ Innovative
• Knowledge in health insurance product in added advantage
• Experience in Health Claim service is advantage.
• Experience with WMS

Qualifications: BA in Business Administration with 2 years of Experience

• Experience in Claims Processing/Claim Adjudication environment.
• Strong data entry and computer navigation skills.
• Capacity to rapidly learn new software and processes.
• Proficiency in Microsoft Office products.
• Good oral and written communication skills.
• Able to work independently.
• Ability to comprehend and apply rules-based decision-making.
• Must be a fast learner, highly motivated, adaptable, flexible, self-sufficient and able to produce quality results in an evolving, fast paced environment.
• Proficient in Microsoft applications and Outlook.
• Good spoken and written communication skills are necessary for daily contact with customers, providers and interoffices.
• Proficient in both spoken and written English, Bahasa Malaysia & Chinese (Cantonese/Mandarin).

Qualifications: BA in Finance with 3 years of Experience

• Strong problem-solving and decision-making skills are critical for success in this role. 
• Exceptionally strong attention to detail and proven follow-through on assigned tasks. 
• Ability to multi-task and work as part of a team or independently to complete tasks and solve problems. 
• Exhibit a clear understanding of time-sensitive deadlines and the ability to complete all tasks within those deadlines. 
• Must possess a high degree of tact, diplomacy and professionalism when interacting with co-workers, providers, and claimants. 
• Demonstrated computer proficiency which includes strong keyboard and navigation skills. 
• Successful completion of new hire training and demonstrated proficiency. 
• Uphold the principles of compliance and fraud management as outlined by corporate and departmental policies. 
• Supports and participates in the mandatory training on an annual or more frequent basis
• Ability to focus effort on goals, meeting or exceeding them, regardless of obstacles. 

Qualifications: BA in Public Health with 4 years of Experience

• Knowledge of Medi-cal Managed Care
• Experience and knowledge of examining and processing claims from the UB04 and CMS-1500 claim forms into the claims adjudication system for all capitated and shared services accounts
• Able to work in a call center environment
• Experience in processing medical claims based on the member’s benefits and provider’s contract. 
• Strong data entry skills and effective team player
• Basic knowledge of medical procedures and terminology
• Ability to foster relationships with co-employees and customers
• Outstanding oral and written communication skills
• Strong ethics and a high level of personal and professional integrity
• Familiarity with federal and state laws and requirements relating to claims administration
• Proficient in using Word and Excel.

Qualifications: BA in Statistics with 3 years of Experience

• Experience in evaluating and processing Health insurance claims in accordance with claim procedures and legislative/regulatory requirements
• Experience in communicating with policyholders, agency personnel, medical providers, and other insurance company personnel
• Experience in participating as an active member of the processor team to ensure the team's goals are being met
• Experience in processing routine claims for Medicare Supplement policies
• Experience in handling the processing of some non-routine claims
• Experience in possessing the competencies to perform in the Health Solution Center
• Experience in handling claim processing for all Health policy types, including Disability Income
• Experience in assisting with project work, as directed by management
• Willingness to assume responsibility and demonstrate initiative.
• Experience processing claims in a healthcare, disability, dental, or long-term care environment OR insurance operations experience.

Qualifications: BA in Risk Management and Insurance with 5 years of Experience