Puerto Rico, Texas

Claim Policy Service Request Associate- Aguadilla, Puerto Rico

In the role of process associate, you will execute transactions as per prescribed guidelines and timelines, reviews and validates the inputs from the other team members, support your manager in training activities, daily operations reviews and help in escalation resolution with the objective to meet service level agreement targets for the specific process within the guidelines, policies and norms of Infosys.

In this role you will be responsible for transition coordination, process training and certifications for the team, talent management related activities, Service Level Agreement compliance and Process compliance. You will also be involved in day to day customer interactions, knowledge management and process reengineering activities.

Location for this position is Aguadilla, Puerto Rico

Basic Qualifications
  • High School Diploma or GED Equivalent
  • Minimum 18 to 36 months in Healthcare claims area
  1. Experience in Healthcare Claims adjudication
  2. Requires in depth knowledge of CPT, ICD-9/10, and HCPC codes
  3. Responsible for accurate and timely processing of Healthcare claim service request and processing claims
  4. Reviews, evaluates the service request as per SOP
  5. Familiar with Medical Policy, Familiar with UCSW service requests, correspondence inquiries and image review
  6. Experience in any claim adjudication platform
  7. Team Work
  8. Must be detailed oriented
  9. Critical thinking and problem solving
  10. Accountability, Adaptability and flexibility
  11. Motivated and ability to learn quickly
  12. Energetic and ability to take constructive feedback
  13. Demonstrated ability to work in a production focused environment
  14. Good verbal and written English communication
Responsibilities Include but may not be limited to:
  • Prep medical records for clinical review
  • End to end processing and resolution of clinical claims and correspondence
  • Understand/interpret medical terminology including clinical notes and reports
  • Able to review medical policies and determine the appropriate claim processing or clinical review process decisions (pay, request additional records, refer for clinical review)
  • Review and determine pricing for clinical claims in accordance with negotiated pricing agreements
  • Adept knowledge of verifying member benefits, eligibility verification and medical necessity determination
  • Forward the cases to appropriate teams, post the in-scope activities have been completed as per SOP
  • NASCO claim processing – adjustments and manual pricing
  • Should be knowledgeable in the use of intranet (OLI, Image, Sharepoint etc) and internet (CareRadius, Encoder Pro, EviCore etc) applications
  • Lotus Notes where the Medical Policy Database, NAEGS and OTT Database are housed

Note: Applicants for employment in the U.S. must possess work authorization which does not require sponsorship by the employer for a visa (H1B or otherwise).

The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone, email or face to face.

About Us

Infosys BPM, the business process management subsidiary of Infosys (NYSE: INFY), provides end-to-end transformative 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 32 delivery centers in 14 countries spread across 6 continents, with 35,058 employees from over 80 nationalities, as of March, 2018.

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.


Puerto Rico, Texas

Infosys was started in 1981 by seven people with $250. Today, we are a global leader in consulting, technology and outsourcing with revenues of $7.126 billion (LTM Q2 FY13). Many of the world’s most successful organizations rely on Infosys to deliver measurable business value. Infosys provides business consulting, technology, engineering and outsourcing services to help clients in over 30 countries build tomorrow’s enterprise.

Our award-winning Infosys Labs and its breakthrough intellectual property can be leveraged as a co-creation engine to accelerate innovation across the enterprise.

Infosys pioneered the Global Delivery Model (GDM), based on the principle of taking work to the location where the best talent is available, where it makes the best economic sense, with the least amount of acceptable risk. Continued leadership around GDM enables Infosys to drive extraordinary efficiencies and free up clients’ resources for strategic transformation or innovation initiatives.

Infosys has a global footprint with 66 offices and 69 development centers in US, India, China, Australia, Japan, Middle East, UK, Germany, France, Switzerland, Netherlands, Poland, Canada and many other countries. Infosys and its subsidiaries have 153,761 employees as on Sep 30, 2012.

Infosys takes pride in building strategic long-term client relationships. 98.2% of our revenues come from existing customers (Q2 FY 13).

Infosys gives back to the community through the Infosys Foundation that funds learning and education.

Similar jobs