Claims Analyst

Job Overview

Under guidance reviews claim submissions, determine eligibility and level of coverage for multiple programs

Essential Functions

• Review claim submissions, determine eligibility and level of coverage for multiple programs

• Enter data, verify details, and update databases with current claim information for approval

• Review and resolve claim discrepancies in a timely manner

• Reprocess claims when necessary

• Managing your assigned queue to keep current on all claims

• Document to ensure an accurate record of events that transpire in the claim handling

• Support outbound calls to patients and/or pharmacies regarding reason for denial and gathering missing documentation

• Recognize repetitive problems or issues and escalate as needed

• Contribute to the successful delivery of team mandate and business objectives

• Ensure that the security and privacy policies, standards and guidelines are understood and applied to protect the informational assets of both the company and our customers

• Other duties as assigned

Qualifications

• Post-secondary degree or diploma with equivalent experience

• Minimum 2 years of experience in healthcare adjudication that required knowledge of cost sharing mechanisms including deductible, coinsurance, and copay

• Ability to use Microsoft Office software proficiently

• Strong attention to detail

• Strong interpersonal and communication skills

• Strong customer focus

• Bilingualism (English & French) is an asset

At IQVIA, we believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. The advanced analytics, technology solutions and contract research services we provide to the life sciences industry are made possible by our 70,000+ employees around the world who apply their insight, curiosity and intellectual courage every step of the way. Learn more at jobs.iqvia.com.