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Executive

Executive

Infinite

2 - 5 years

4 - 7 Lacs

bengaluru

Posted:-1 days ago| Platform:

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Skills Required

health insurance service level windows os snp hipaa cms support services data privacy customer service us healthcare

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Description
The Customer Support Agent will be responsible for handling US health insurance Claims from healthcare providers or their authorized representatives. The Agent will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines.
Key Responsibility
Handles Claims related to providers:
Benefits, eligibility, claim status, Claims adjudication Claim research and Explanation of Benefits (EOB) Utilize internal systems and tools (via secure access methods) to retrieve and update information. Document all the daily tasks related to Claims adjudicated in the system. Escalate unresolved cases to the appropriate internal departments. Communicate clearly, concisely, and professionally with customer. Adhere to all privacy laws and regulatory compliance requirements related to CMS and HIPAA. Meet performance targets and service level agreements (SLAs).
Required Qualification
High school diploma or equivalent (mandatory)
Some college education or a completed degree (preferred) Strong command of the English language (verbal and written) Basic knowledge of Windows OS and Microsoft Office tools
Required Experience
2 5 years of Claims Adjudication (preferably in healthcare or insurance)
Experience working in office environment with US healthcare background
Familiarity with claims processing systems and provider portals (preferred)
Experience on Medicare plans especially on I-SNP will be an added advantage. Clear knowledge on different types of facilities in US healthcare like SNF, NF etc.,
Behavioral Attributes
Empathy: Understands and acknowledges provider concerns
Professionalism: Maintains a calm and respectful tone under pressure Accountability: Takes ownership of responsibilities and outcomes Adaptability: Flexible with process changes and system updates Confidentiality: Complies with data privacy standards and regulations
Competency
Excellent Communication: Ability to articulate clearly and listen actively
Problem Solving: Uses logic and reasoning to resolve issues effectively Technical Proficiency: Comfortable navigating multiple systems and platforms Time Management: Handles tasks efficiently while meeting deadlines Customer Centricity: Focused on delivering a positive provider experience Team Collaboration: Works well with others and contributes to team success

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