Roles & Responsibilities: Manage inbound & outbound calls from US providers, pharmacies, and members regarding benefits or claim denials. Handle US Medical/PBM denied claims and Utilization Management (PA, Appeals, etc.). Manage RCM cycle for patient financial encounters. Evaluate documents to ensure accurate claim information. Resolve customer queries and complaints professionally. Adhere to call center scripts, maintain quality standards, and prepare reports. Requirements: 23 years of US Healthcare voice process experience. Excellent communication skills. Comfortable with rotational shifts (247) and working on Indian holidays. Strong knowledge of claims handling and CRM systems . Customer-focused, adaptable, with good problem-solving skills. Must be willing to work in a voice process .
Role & responsibilities Experience : 1- 6 years of US Calling Experience. Responsibilities: Manage Inbound & Outbound calls and customer service enquiries, in this profile specifically agent will be answering an inbound calls which they will receive from the providers/pharmacies/members to seek assistance on benefits or on claim denials. US Medical/PBM denied Claims Handling process. Utilization Management handling including PA, Appeals, etc. RCM cycle that is used to manage the financial cycle of a patients encounter. Management and resolve customer complaints Identifying customers needs, clarify information, research every issue and providing solutions Following call centre scripts when handling different topics Work with the team to resolve issues with good aptitude Maintain and prepare activity reports. Maintains and improves quality results by adhering to standards and guidelines, recommending improved procedures Requirements: Previous experience in US Voice Process Should be comfortable with rotational shifts and offs. Should be comfortable with working on Indian Holidays. Should be well versed with end to end claims handling process. Strong phone and verbal communication skills along with active listening Familiarity with CRM systems and practices Customer focus and adaptability to different personality types Ability to multi-task, set priorities and manage time effectively Mandatory Skills/Experience: Excellent communication skills (written and verbal). American accent would be preferable. Should be comfortable with rotational shifts and offs. Should be comfortable with working on Indian Holidays. Candidates must be willing to work in Voice process.
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