Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Third-party administrators for pharmacy benefits, health claims, and pension funds receive eligibility files, process claims against plan rules, coordinate with pharmacies and providers, generate explanations of benefits, handle appeals, and manage payments to providers while the plan sponsor confirms all rules, payments and filings.
Specialist bots
- Eligibility Coordinator: Load, validate and reconcile incoming eligibility files from plan sponsors.
- Claim Adjudicator: Apply plan rules to incoming pharmacy and medical claims and calculate payable amounts.
- Prior Authorization Specialist: Process prior authorization requests, apply clinical criteria and track decisions.
- Payment and Rebate Reconciler: Aggregate claims, prepare payment files, calculate rebates and reconcile accounts.
- Appeals and Grievance Handler: Track, process and respond to member and provider appeals and grievances.
- Reporting and Document Analyst: Compile reports, maintain plan documents and prepare materials for sponsor review.
Industries (NAICS)
Templates describe drafts and checklists a bot prepares for you to review. They are not professional advice and do not act on your behalf without your approval.