Executive- PIM at EXL South Africa

Job Description

• The intake agent will receive and review the fax images and start data entry in the system.
• Validate and verify the provider and member using all compliance metrics.
• Create the precert case and route the case to the appropriate bucket for initial or final review.
• Attach the fax for existing precert cases needing additional information.
• Intake agent needs to determine whether case should be cancelled or build
• Investigate previous case history to determine case outcome
• Fax back providers
• Research certain drugs
• Data capture from system to template.

Responsibilities

• Navigate through multiple systems / applications for data gathering
• Proficiency with computer skills (navigating multiple systems and keyboarding)
• Understand the goals and standards to ensure that quality and productivity standards are met
• Accurate and timely updating of the database
• Meet the agreed upon KPIs as per the operational definitions and targets
• Participate in the User Acceptance Testing as needed
• 98% - 100% attendance during training/nesting period is required
• Tying speed – 25-30 words/minute with 90% accuracy
• Must be flexible to work hours with Monthly work schedules changes

Qualifications

• Education Level - High School Graduate (NSC