Assess Special Authorization requests by applying clinical expertise and evidence-based guidelines to determine medication coverage eligibility. Document decision rationales in company systems and provide professional correspondence to prescribers and subscribers regarding coverage outcomes.
The role involves driving market share through consistent sales performance and managing a high volume of inbound and outbound customer calls. You will also collaborate with internal stakeholders to ensure exceptional customer service and administrative accuracy in contract processing.
The Contract Administrator is responsible for the accurate and timely generation of new group contracts and existing contract amendments. They also handle complex enrollment issues and collaborate with internal departments to ensure benefit accuracy.
The Payment Specialist is responsible for calculating and processing life and disability payments while ensuring compliance with contract terms and internal approvals. They also manage overpayments, financial reporting, and year-end tax documentation.
The administrator acts as the primary point of contact for group plan inquiries, managing inbound communications and providing online demonstrations. They are also responsible for conducting research to resolve issues, performing monthly audits, and maintaining accurate system records.
The representative responds to telephone inquiries from health care providers regarding benefit eligibility, claim submissions, and plan requirements. They are also responsible for logging call details, verifying claims through adjudication systems, and suggesting workflow improvements.
The representative responds to telephone inquiries from health care providers regarding benefit eligibility, claim submissions, and plan requirements. They also document call details, analyze workflows, and provide feedback to management to improve processes.
The analyst is responsible for assessing and rendering decisions on special authorization requests for drug coverage according to established guidelines. They also manage electronic documentation, perform system entries for claims adjudication, and handle customer inquiries.
