BPO HC & Insurance Operations Associate

Position's 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