Hiring For Enrollment - SPE / SME Career Guideline

2.0 - 7.0 years

1 - 6 Lacs

Chennai, Coimbatore

Work from Office

Hiring for Enrollment ( Us Healthcare ) Process : Non voice Location - Coimbatore / Chennai Timings - US Night shift ( 5:30pm to 3:30 am ) Mode - Work From Home Notice Period - Immediate to 15 Days SPE - Upto 5 Lpa SME - Upto 6.4 Lpa SPE 2+yr exp in Enrollment ( Us Healthcare ) SME 4+yr exp in Enrollment ( Us Healthcare ) Interested Candidates contact HR Dinesh@ 9353611283 dinesh@careerguideline.com

Posted 6 days ago

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Team leader operations For Provider configuration- Coimbatore Sagility India

5.0 - 8.0 years

4 - 6 Lacs

Coimbatore

Work from Office

Job Title: Team Leader-Provider configuration- Coimbatore & Claims Adjudication (US Healthcare) Experience: 5-8 years Qualification: Bachelors degree Shift: Night shift Transportation: Pick up and drop would be provided Job Summary: Team Leader - Provider configuration- Coimbatore and Claims Adjudication will oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction. Key Responsibilities: Team Management & Leadership: Lead, mentor, and manage a team handling enrollment, Provider configuration- Coimbatore and claims adjudication processes. Monitor team productivity, quality, and adherence to service level agreements (SLAs). Provide training, coaching, and development opportunities to team members. Conduct regular team meetings, performance reviews, and provide constructive feedback. Resolve escalations and complex issues promptly and professionally. Enrollment Management: Oversee new member enrollment, renewals, terminations, and updates in healthcare plans. Ensure data accuracy for member eligibility, coverage, and benefits. Collaborate with clients and internal teams to resolve enrollment discrepancies or queries. Claims Adjudication Oversight: Supervise the processing of healthcare claims ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.). Ensure proper review of claims for eligibility, benefits coverage, coding, and payments. Monitor claim denials and implement corrective action plans to reduce errors and rework. Process & Compliance: Ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines. Identify process improvement opportunities and work with quality teams to implement best practices. Prepare and analyze reports related to team performance, quality audits, and operational metrics. Liaise with clients and stakeholders for updates, process changes, or reporting needs. Required Skills and Qualifications: Bachelors degree or equivalent work experience in healthcare operations. Minimum 5-6 years of experience in US healthcare processes, with 1-2 years in a team leadership role. SMES and Quality analysts are eligible to apply Strong knowledge of US healthcare insurance, including enrollment, eligibility, Provider configuration, claims processing, and adjudication rules. Familiarity with CMS, Medicaid, Medicare, ACA, and HIPAA regulations. Proficient in claims platforms Excellent analytical, problem-solving, and decision-making skills. Strong communication and interpersonal skills. Ability to multitask and work under pressure. Interested candidates can share your resume to anitha.c@sagilityhealth.com

Posted 2 weeks ago

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