BPO HC

General Duties and Tasks

In these roles you will be responsible for:
Review and process insurance claims. Validate Member, Provider and other Claim’s information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines

Requirements for this role include:
University degree or equivalent that required formal studies of the English language and basic Math 1+ years of experience where you had to apply business rules to varying fact situations and make appropriate decisions 2+years of adjudication experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product. 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 6+ months of experience that required prioritizing your workload to meet deadlines

Preferences: - Optional (nice-to-have’s)
Ability to communicate (oral/written) effectively to exchange information with our client. Commerce graduate with English as a compulsory subject

Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement