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Claims Associate  (B.Pharma)  Sr.Claims Associate  (B.Pharma) Reference Guide > About Us: UnitedHealth Group is a diversified health and well-being company dedicated to making healthcare systems work better.  The company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services, simplify the healthcare experience, promote quality, and make healthcare more affordable. UnitedHealth Group has had a presence in India since 2002 through United Healthcare India and its affiliate companies.  UnitedHealth Group Information Services in Gurgaon, the latest addition to the family of businesses in India, is the largest international location outside of America.  Overview: Healthcare Business Services (HBS) is responsible for providing health care back office operational services as a core function to various segments of UnitedHealth Group. The team has well defined HIPAA compliant processes for its business operations with primary focus on quality of delivery. Since its inception in October ’06, HBS has been focused on hiring top talent in the industry and enhancing their health care expertise to manage all facets of the claims lifecycle for our global partners. It’s our continual effort to deliver on core services, diversify the portfolio and align ourselves with business segments strategic objectives.   Sr.Claims Associate  (B.Pharma) Requisition No: 375311 Job Responsibilities: 1. Analyze benefit requests and secure all necessary data to ensure appropriate implementation -   ·         Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system. ·         Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system. ·         Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system.   2. Develop and run macros in RxCLAIM to implement plan requests.   3.  Maintain acceptable and appropriate quality levels and production turnaround times   4.  Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal department.   5.  May be assigned to work on special projects and business initiatives.   6.  Ability to understand and apply plan concepts to include:  ·          Deductible ·          Coinsurance ·          Copay ·          Out-of-pocket ·          Maximums, inside limits and exclusions.  Desired Criteria: Attention to detail. Quality focused. Written and verbal communication skills. Knowledge of AS400 application Team player. Problem solving.    Ability to work without close supervision. Essential criteria:   Candidate should have B.Prarma degree 18 months or above experience in any BPO/KPO Open to work in Night Shifts Good hand on MS-Office with focus on MS-Excel Good Analytical & comprehension skills     Click here to submit | Back top    Claims Associate  (B.Pharma) Requisition No: 375313 Job Responsibilities: We are currently looking for dedicated professionals to fulfill the following job responsibilities:   1. Analyze benefit requests and secure all necessary data to ensure appropriate implementation - Ø   Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system. Ø   Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system. Ø   Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system.   2. Maintain acceptable and appropriate quality levels and production turnaround times 3. Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal department. 4. May be assigned to work on special projects and business initiatives. 5. Ability to understand and apply plan concepts to include: ·         Deductible ·         Coinsurance ·         Copay ·         Out-of-pocket ·         Maximums, inside limits & exclusions ·         State variations Desired Criteria: Attention to detail. Quality focused. Written and verbal communication skills. Team player Ability to work without close supervision.  Essential criteria:   Candidate should have B.Prarma degree - We do not accept “Results awaited” candidates 0- 12Months of experience in any BPO/KPO Good Analytical & comprehension skills Open to work in Night Shifts Good hand on MS -Office with focus on MS-Excel Click here to submit | Back top    *It is mandatory to submit your referrals online for referral bonus.   Click here to submit