Provider Access System Associate

Summary

Provide support for the ProHealth system, ensuring that the application is accurately updated with new information and changes to existing information for plans, members, and dependents. Ensure that claims processed through the system are accurate thereby reducing the need for manual intervention during claim payment. Train staff to access information using ProHealth in order to assist providers who use the system to submit claims.

Responsibilities

• • Create new Plan ID’s, benefit codes and benefit lists within the Pro-Health system in accordance with benefit schedules submitted by the Insurance and Pension Revenue team for ALL new and renewing cases including any changes submitted during the contract year, or from the Department based on errors reported.
• • Provide support to Sagicor’s Client Support Department, GIAs and Providers, re the handling of queries within the Pro-Health System within normal business hours, off peak hours and weekends as scheduled.
• • Obtain daily error reports resulting from the upload of eligibility information from GIAS; also, check errors and perform any action required to ensure correct information on Pro-Health.
• • Audit PAS-Claim Discrepancies making comparisons with GIAS and Pro-Health systems and ascertain the sources of error.
• • Assist with performance of testing within the Pro-Health system.
• • Perform duties relating to projects and complete monthly activity report for submission to the Supervisor.
• • Complete pre-authorized requests for extension of prescription drug benefits, and pre-approvals for the extended supply of medication submitted by subscribers, brokers, and HRD Administrators.
• • Perform other job-related duties assigned from time to time.

Required Skills

• • Comprehensive working knowledge of GIAS Software & ProHealth systems.
• • In-depth knowledge of claims processing procedures.
• • Ability to maintain high levels of confidentiality.
• • Keen attention to details and ability to work with a high level of accuracy.
• • Working knowledge of computer software packages such as word processing and spreadsheet applications.

Qualifications

• • Associate’s Degree in Business, Management, Marketing or a related discipline from a recognised tertiary institution.
• • HIA (Parts A & B) and LOMA (Parts 1 & 2) designations.
• • Two (2) years’ working experience in the insurance industry, preferably in the operations division of a life or health insurance company.

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