5 Member Enrollment Jobs

Urgent Hiring for- Role - QA Lead / Architect Location : Chennai , Bangalore, Hyderabad, Pune Mandate Skills : Functional Testing, Automation Testing , End to End US healthcare (Member Enrolment, Claims, Prior Authorization, Encounters and Care Management) Note- Strong experience in EDI with 8 years of experience in healthcare domain. Key Responsibilities: Develop, execute, and maintain end-to-end test scenarios spanning multiple healthcare domains (Member, Enrolment, Claims, Prior Auth, Encounters, Care Management). Collaborate with Business Analysts, Product Owners, and Stakeholders to understand requirements and translate them into comprehensive test strategies. Conduct functional, Automation , integration, regression, and UAT support testing across cross-functional modules. Validate data flow across systems (EDI, downstream platforms, provider/member portals, etc.) and ensure alignment with business rules. Identify data requirements and create test data (including mock EDI files like 834, 837, 278, etc.). Drive root cause analysis of issues and work independently to resolve or escalate with minimal dependency on development teams. Ensure compliance with HIPAA and industry standards across testing activities. Participate in Agile ceremonies, providing test status, risk assessment, and quality insights. Required Skills: Strong domain expertise in US Healthcare : Member Management, Enrollment (834) , Claims (837P/I), Prior Authorization (278 ), Encounters and Care Management workflows. Hands-on experience with EDI formats , healthcare platforms, and data validation tools. Proven ability to work independently , drive testing strategy, and challenge assumptions. Experience with tools such as JIRA, qtest, ADO, SQL, Postman , and test automation basics (TOSCA, optional but a plus). Strong communication and analytical skills to work across cross-functional teams. Ability to troubleshoot data and integration issues across APIs, DBs, and EDI feeds Interested candidate can share updated resume at axum@vishusa.com

Location: Chennai, Bangalore, Hyderabad, Pune & Baroda Work Mode : Hybrid Exp : 10+ Yrs Looking for Immediate to 15 Days joiners only, since we are planning to kick start this project by Aug 1st week. We are seeking a detail-oriented and proactive End-to-End Test lead, preferably 12+ years with strong expertise across Member Enrollment, Claims, Prior Authorization, Encounters and Care Management domains in the US healthcare ecosystem. The ideal candidate is an independent thinker , able to design and execute test strategies, ensuring comprehensive coverage and quality in complex healthcare systems. Key Responsibilities: Develop, execute, and maintain end-to-end test scenarios spanning multiple healthcare domains (Member, Enrollment, Claims, Prior Auth, Encounters, Care Management). Collaborate with Business Analysts, Product Owners, and Stakeholders to understand requirements and translate them into comprehensive test strategies. Conduct functional, integration, regression, and UAT support testing across cross-functional modules. Validate data flow across systems (EDI, downstream platforms, provider/member portals, etc.) and ensure alignment with business rules. Identify data requirements and create test data (including mock EDI files like 834, 837, 278, etc.). Drive root cause analysis of issues and work independently to resolve or escalate with minimal dependency on development teams. Ensure compliance with HIPAA and industry standards across testing activities. Participate in Agile ceremonies, providing test status, risk assessment, and quality insights. Required Skills: Strong domain expertise in US Healthcare : Member Management, Enrollment (834), Claims (837P/I), Prior Authorization (278), Encounters and Care Management workflows. Hands-on experience with EDI formats , healthcare platforms, and data validation tools. Proven ability to work independently , drive testing strategy, and challenge assumptions. Experience with tools such as JIRA, qtest, ADO, SQL, Postman , and test automation basics (TOSCA, optional but a plus). Strong communication and analytical skills to work across cross-functional teams. Ability to troubleshoot data and integration issues across APIs, DBs, and EDI feeds.

Location: Bangalore (Work from Office) Grade: G Designation: Team Executive Shift: Night shift Number of Positions: 1 About the Role: We are seeking a dynamic and experienced Team Lead with a strong background in US Healthcare , specifically in Member Enrollment . The ideal candidate will have proven experience in managing teams, excellent communication skills, and a deep understanding of the healthcare domain. This is a Team Lead role and requires hands-on leadership experience in enrollment processes. Key Responsibilities: Lead and manage a team responsible for US healthcare member enrollment activities. Ensure compliance with CMS guidelines and support processes related to Medicare (preferred). Monitor team performance and provide regular coaching, feedback, and performance reviews. Prepare and maintain internal and client reports accurately and on time. Coordinate and conduct training sessions for new and existing team members. Act as a liaison between the team and upper management, ensuring seamless communication. Handle team escalations and resolve operational issues efficiently. Ensure adherence to quality, compliance, and productivity standards. Mandatory Skills: Proven Team Lead experience (on paper). Strong knowledge of the US Healthcare system . Hands-on experience in Member Enrollment processes. Willingness to work night shifts Preferred Skills: Exposure to Medicare processes and guidelines. Familiarity with CMS compliance standards. Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or deepalakshmi@firstsource.com email addresses.

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

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