Claims Processor / Indexer - Pharmacy - South Carolina

  • Full-time

Company Description

WNS (Holdings) Limited (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. 

WNS South Carolina - Strategically located to meet the onshore delivery requirement of our US clients and for favorable business environment, stable job market and supportive local government. World-class communication network and large power grids support the needs of 24/7 operation. WNS Manages high end businesses, providing strategic solutions and supporting transformational process.


Why Join Us?

Experience the culture of outperformance, engagement, celebration and enjoy wide variety of best benefits like 401K, Health, Dental, Vision, PTOs etc
At WNS, our mission is to enable clients to outperform with our passion for service and innovation. At the heart of each client engagement is our pursuit to understand our client’s business, and create impactful solutions that can drive agility and excellence into their business processes. Our promise of outperformance stems from our deep domain expertise, partnership approach and a global delivery network.
Our mission as an organization is guided by our CIRCLE of values: Client First, Integrity, Respect, Collaboration, Learning, Excellence.

Job Description

**This is an example for reference, kindly edit basis role requirement** 

Evaluation and processing of pharmacy claims accurately and in a timely and efficient manner.

Responsibilities of Position:

Member eligibility inquiries, including location by member ID and/or by member name and DOB
Accurate data entry of all member information
Accurate navigation between queues, and accurate movement of claims to the appropriate queue
Evaluation of member details and claim history for determination of what needs to be done with a claim
Turn-around-time adherence
Accurate data entry of all claim information, whether provided by the member, client, or pharmacy
Maintenance of one’s quality and productivity scores to ensure all client expectations are clearly met
Evaluation of claims processed previously—with corrections where necessary—for quality, validity of rejections, or additional required information that may need entering
Additional duties as assigned by manager

Qualifications

Preferred Experience :

Pharmacy Technician experience, or
Medical Billing/Coding, Medical Tech, or Nursing Assistant

Experience Requirements of Position:

Ability to read and type at a skilled level
Understanding of how to use cloud-based web applications and mainframe web applications
Ability to read member notes and interpret correctly to determine what needs to be done with a DCN or claim
Ability to determine appropriate claim type, based on the image provided
Ability to adapt to change with fluidity and clarity, without error
Organizational skills
Ability to maintain quality and productivity scores effectively and consistently
Detail-orientation
Understanding, acknowledgement and practice of all HIPAA laws

 

Additional Information

All your information will be kept confidential according to EEO guidelines.
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