Healthcare and Insurance Operations Analyst

HC and Insurance Operations Sr Associate

Role Responsibilities:

 

• In-depth knowledge and experience in the US healthcare (Non Voice) – Membership enrollment and billing.
• Ability to train the team on new process and process updates.
• Calibrate with QA’s to ensure process knowledge and variance are managed and under control.
• Ability to create Process SOP, Process Map and identifying the outlier within process.
• Review Discrepancy report and comments, identify gaps and share with TL.
• Identify NVA and provide suggestion for automation opportunities.
• Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
• Drive team from the front in case of leadership unavailability.
• Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
• Oversee data integrity of member enrollment records and remittance files transmitted from the state.
• Provide timely, efficient support for the eligibility load process while coordinating with corporate IS department to resolve issues that arise during the process.
• Provide research to correct errors in membership and Primary Care Physician data output within the provider information system.
• Research information on members/subscribers to resolve problems and disputes.
• Maintains quality and production standards as outlined by government regulations and department policies & procedures.
• Completion of volumes in queue within specified Turn Around Time.
• Ability to meet their required production and Quality target.
• Setting productivity /Quality benchmark
• Handles internal and external inquiries concerning billing, enrollment of member or subscriber.

 

 

Required Skills:

 

• Ability to work regularly scheduled shifts from Sunday - Saturday 5 PM IST time to 8 AM IST (5 days working).
• University degree or equivalent that required 3+ years of formal studies.
• Work from Office.
• No transport facility (Own transport).
• Ability to work in a team environment.
• Good logical thinking ability.
• Good English Comprehension/written skills should have exposure to MS Office.
• Good Communication Skills – Both Verbal and Written
• Ability to interact with clients preferred.

 

 ** Schedule availability for this position is Sunday - Saturday 5 PM IST time to 8 AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime, holiday working and weekend working as per business requirement.

Experience Level

Senior Level