Intake Coordinator
Aguadilla, Puerto Rico
Job Type: Full Time (Onsite)
Job Summary:
This job captures all inbound requests for utilization review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax or phone, and at times may require follow-up calls with physicians or pharmacists.
Principal Duties and Responsibilities:
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- Obtain requests from provider or pharmacy via phone, fax, or provider portal (online). Use multiple software systems and various resource sites to determine member plans and requirements. Gather all required documentation including verification of benefit eligibility. Build cases in the utilization management system.
- Use knowledge of process and judgement to evaluate identified cases that require additional notification to member, provider, and/or pharmacist. At times, contact by phone members, providers and/or pharmacists to obtain additional information.
- Ensure accuracy of data entry to prevent compliance and/or downstream process issues.
- Other duties as assigned.
Basic:
- High School Diploma/GED required
- 1 years of Customer Service experience required
- 0 - 1 year of experience working in the Health Insurance Industry preferred
- Prior experience working in a call center environment is a plus
- Problem Solving & Decision Making
- Compliance
- Good hold on English as a language of written, spoken and as a language of official communication in a professional environment.
- Clinical Analytic Skills.
- Excellent computer skills including experience with Microsoft Office products
- Healthcare Industry
- Health Insurance background
Infosys BPM Limited, a wholly owned subsidiary of Infosys Limited (NYSE: INFY), provides end-to-end transformative business process management (BPM) services for its clients across the globe. The company's integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering , automation , and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.
Infosys BPM has 45 delivery centers in 16 countries spread across 5 continents, with 58,090 employees from 111 nationalities, as of June, 2024.
The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years. The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices. The company's senior leaders contribute widely to industry forums as BPM strategists.
EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin
Infosys is an equal opportunity employer and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability