FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing and processing provider bills, utilizing AI-based screening tools for accurate insurance claim entry, and maintaining confidentiality of insured member data. Strong communication and organizational skills are essential for effective collaboration with various departments and timely resolution of claims.
Highest-signal resume keywords
Pharmacy DegreeHealth Care Industry ExperienceAI-Based Screening ToolsClaims ProcessingMS Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingBilling AuditingInsurance Claim EntryData ManagementInvoice RecordingClaim AdjustmentsMedical Record ManagementPolicy ComplianceTATSH System ProficiencyData Governance
Soft Skills
TeamworkCommunicationOrganizational SkillsFlexibilityCommitment to Results
Tools & Technologies
AI ToolsMachine LearningCloud-Based ToolsAnalytics Software
Industry Keywords
Health CareTPAInsurance CompaniesMedical CentersProvider Discounts
Tech Stack
Tools & technologiesCloud
About the role
Key responsibilities & impact- Audit and process all types of providers’ bills
- Examine claim documents thoroughly
- Apply correct pricing before processing bills in TATSH
- Handle claim adjustments
- Use AI-based screening tools to verify accurate insurance claim entry and timely payment
- Verify required TATSH fields, including visa notes, precertification center notes, contract notes, policy files, medical files, and faxes
- Process and record invoice details according to policy terms, product type, TOB, and information from medical auditors, providers, and precertification officers
- Follow up daily on pending claims or issues with relevant departments until resolved
- Notify the Network department about jumbo claims to secure special provider discounts
- Report provider deviations from agreed tariffs to the Network department
- Report payer or provider invoice complaints to the Team Leader or Manager
- Communicate requests or required information from other departments to the Team Leader or Manager
- Adhere to departmental internal procedures
- Maintain confidentiality and properly manage insured member data, system information, policies, and medical records
- Perform other duties assigned by the Direct Manager
- Work effectively with AI, machine learning, data, analytics, and cloud-based tools while following data governance, security, and ethical-use standards
Requirements
What you’ll need- Pharmacy Degree
- Minimum 2 years in the Health Care Industry, including TPA’s, insurance companies, hospitals, or medical centers
- Strong commitment to delivering results
- Ability to meet deadlines consistently
- Excellent teamwork skills
- Outstanding communication and organizational abilities
- Flexibility to work shifts
- Willingness to work overtime when necessary
- Basic proficiency in MS Office applications
Benefits
Comp & perks- Permanent employment
- Inclusive workplace and equal opportunities
- AI, machine learning, data, analytics and cloud-based work environment
- Opportunities to change positions and collect experiences across Allianz Group
- Employee development and career growth opportunities