Associate III - BPM

Job Description

3 - 5 Years 10 Openings Bangalore, Chennai, Kochi, Trivandrum Role description 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: Independently achieves the following; guiding other process associates and assists Lead 1 - BPM Service Level Agreement (SLAs) specified by the client in terms of quality productivity and schedule should be managed to ensure 100% adherence. Data: Analyze information enter and verify data follow the SOP to ensure completion of the task. Voice: Customer calls responses and any updates or edits to workflow based on after call work should be performed as per directions. Address performance issues and improvement plans of team and self with supervisor. Expected to be proficient in the process and domain to ensure quality of transactions and guide the same to the process associates. Perform QA for production associates as an expert in the function and ensure completion within SLAs. Create reports on performance metrics for team to manage productivity. Understand the process and bring forward ideas and solutions to simplify and automate them to increase operational efficiency. Create automation solution and submit the same to Lead I for review. Measures of Outcomes: 100% Adherence to quality standards Adherence to turnaround time for response and resolution Completion of all mandatory training requirements 100% adherence to process and standards 100% adherence to SLAs where applicable Number of issues fixed/tasks completed Number of non-compliance issues with respect to SOP Zero/No Client Escalations Number of high-quality RCA and QA output Daily/weekly performance reporting Mentors A1 and A2 resources on the processes Outputs Expected: Processing Data: Processing transactions assigned as per SOPs Handling calls Voice: Handle customer support calls resolve issues and complete after-call work Production: Take calls (voice) or process complex transactions (data) Issue Resolution: Address any problems with the supervisor/QA to ensure maximum productivity and efficiency. Identifies analyses and solves the incidents/transactions. Productivity: Proficient in the process assisting other team members who are new to the process as well to ensure quick readiness of the team. Take steps to improve performance based on coaching. Production readiness of new joiners within agreed timeline by providing guidance Actively participate in the team's or organization wide initiatives Able to handle and manage higher complexity tasks. Adherence: Be aware of any clients process or product updates and ensure 100% compliance towards the same. Adhere to release management process. Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization’ s policies and business conduct. Reporting: Create reports on specific SLAs/performance measures/KPIs Stakeholder Management: Guide the team in preparing status updates and keep management updated about the status. Training : Attends one on one need-based domain/project/technical trainings as needed. On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one to one mentorship for new joiners. Escalation: Escalate problems to appropriate individuals/support team based on established guidelines and procedures. Monitoring: Monitor progress of requests for support and ensures users and other interested parties are kept informed. Manage knowledge: Consume project related documents share point libraries and client universities Mentoring: Mentor and provide guidance to peers and junior associates. Assist new team members in understanding the customer environment. Communication: Status update to the respective stakeholders and within the team Collaboration: Collaborate with different towers of delivery for quick resolution (within SLA); document learning's for self-reference. Collaborate with other team members for timely resolution of errors. Skill Examples: Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met. Attention to detail to ensure SOPs are followed and mistakes are not knowingly made Team Work: Respect others and work well within the team. Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data) Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice) Typing Speed with 15WPM and 80% accuracy Analytical approach: Makes systematic judgments based on information and relevant assumptions. Ability to follow SOP documents and escalate the s within the defined SLA Willingness and ability to learn new skills domain knowledge etc. Make rule based and discretionary decisions. Process Trainer/Sr. QA/Domain Expert/MIS Analyst Frontline resource - Voice/Backoffice Quality Auditors SME Domain Experts 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: Responsible for the accurate processing and completion of medical claims based defined claims guidelines and policies. Associate can demonstrate proficiency in product lines applicable to the processing unit. - Process new claims or modifies existing claims according to the appropriate and applicable action - Analyze claims to determine appropriate action to approve or deny a claim for payment - Determines accurate payment criteria for clearing pending claims based on defined policies and procedures - Researches claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims - Reviewing and addressing provider inquiries regarding claim adjudication, and other Claims matters. - Assisting and or communicate with the Providers to understand the issues on claims brought in. - Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process - Demonstrate ability to work on high volume of repetitive claims - Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards. - Ready to work on a fast paced learning process and highly engage to complete the huge backlog of claims. Education - Bachelor’s Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession - Credential/Professional Certification related to current work is an advantage Work Experience - Should have 2 to 5 years of medical claims processing experience - Experience with medical coding to include diagnosis coding and terminology is an advantage - Experience in Claims Processing is a MUST. - Experience in Claims Denials, Appeals and Grievance is highly recommended Skillset - Proficient knowledge on US Healthcare Practice, Excellent verbal and written business communication skills required - Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel - Strong attention to detail and the ability to make appropriate decisions based on information presented Skills Claims Processing ,Claims Denials, Us Healthcare About UST UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.