Associate III - BPM

3 - 5 Years
5 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: 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 claims processing or related healthcare domain Communication: Excellent verbal and written communication skills Purpose: The Provider Inquiry & Claims Specialist is responsible for accurately reviewing and resolving provider inquiries received through the ticketing system and support resolving inquiry activities in accordance with established guidelines and policies. This role requires strong analytical skills, attention to detail, and the ability to collaborate across teams to ensure timely and accurate provider support and claims processing. Key Responsibilities: Review, investigate, and resolve provider inquiries via the ticketing system (OneHub) Assist providers by clarifying payment determinations, claim status, and policy-related queries Route or coordinate requests with adjustment/claims team when correction or reprocessing is required Analyze claims to determine accurate payment or denial decisions as per policy and benefits Apply appropriate benefits, edits, and pricing guidelines, including physician contract pricing Maintain thorough documentation and follow up on pending provider requests Handle a high volume of repetitive tasks efficiently while maintaining accuracy and compliance Continuously improve productivity and achieve required quality and SLA targets Adapt quickly to system updates, process changes, and new learning requirements Uphold UST values - Integrity, Customer Centricity, Innovation, Collaboration, Excellence, Respect Preferred Skills & Experience Experience in US Healthcare claim adjudication or provider inquiry handling Working knowledge of HealthEdge, CFI, CFS, OneHub is a strong advantage Strong analytical and problem-solving skills with good written and verbal communication

US Healthcare Claim,Analytical,Communication,Healthedge/CFI/CFS/OneHub