Associate III - BPM

3 - 5 Years
2 Openings
Trivandrum

Role Proficiency:

A Voice Associate Able to independently take customer support calls effectively and efficiently ;follow the SOPs to complete the process and endeavour to resolve the issue handle some escalated issues or escalate to a more knowledgeable person to resolve in alignment with SLAs and assists Lead I – BPM.rnA Data Associate should independently be able to effectively and efficiently process the transactions assigned in timely manner clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained in alignment with SLAs and assists Lead I – BPM.

Outcomes:

Measures of Outcomes:

Outputs Expected:

Processing Data:

Handling calls Voice:

Production:

Issue Resolution:

Productivity:

Adherence:

Reporting:

Stakeholder Management:

Training :

Escalation:

Monitoring:

Manage knowledge:

Mentoring:

Communication:

Collaboration:

Skill Examples:

Knowledge Examples:

• Expertise with Windows Operating Systems MS Office tools
  • English comprehension – Reading writing and speaking

  • Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)

  • Familiarity with work allocation and intake functions

  • Familiarity with quality control processes including pare to analysis and root cause analysis

  • Knowledge on security policies and tools

  • Good understanding of customer infrastructure ability to co-relate failures

  • Experience level – 3 to 7 years
  
  
  Additional Comments:

  Job Title: Medical Claims Examiner (US Healthcare Payer) Shift Timings: 5:30 PM to 2:30 AM (5 days in office) Education: Graduate (Any discipline) Experience: 3+ years in medical claims processing or related healthcare domain Communication: Excellent verbal and written communication skills Purpose: The Medical Claims Processor will be responsible for the accurate processing and completion of medical claims in accordance with defined claims guidelines and policies. The associate will demonstrate proficiency in the product lines relevant to the assigned processing unit and contribute to efficient claims adjudication. Key Responsibilities: Process new claims or modify existing claims according to applicable guidelines and defined actions. Analyze claims to determine appropriate actions for approval or denial of payments. Determine accurate payment criteria to clear pending claims based on policies and procedures. Research claims edits to apply appropriate benefits, utilizing established criteria and physician contract pricing as needed for entry-level claims. Review and address provider inquiries related to claim adjudication and other claims matters. Assist and communicate with providers to understand and resolve issues related to claims. Manage a high volume of repetitive claims efficiently while maintaining accuracy. Demonstrate continuous improvement in productivity to meet or exceed minimum requirements while ensuring quality standards. Adapt to a fast-paced learning environment and actively engage in clearing the backlog of claims. Adhere UST Values - Integrity, Customer Centricity, Innovation, Collaboration, Excellence, Respect

Medical Claims,Us Healthcare,Communication