US Health insurance claims

Job Description -

 

Oversee the day-to-day health insurance claims operations, customer service, and quality control (Focused towards BackOffice Processes), Maintain and improve as per SLAs /KPIs over the month at a process level(Focused on Back Office Processes)

Ensure that all processing is completed in a timely and accurate manner, with a focus on meeting or exceeding service level agreements

 

Competencies & Skills

1. Knowledge of the function, process and systems.
2. Ability to use the desktop computer systems
3. Coaching and Feedback ability.
4. Clear written and verbal communication.
5. Medical knowledge and understanding of medical terminologies 

 

Roles and Responsibilities

 

• Monitor transactions on an ongoing basis and take corrective steps where necessary or make incremental improvements.
• Provide coaching and feedback to team members to enable them to improve their performance. 
• Assist new hires such that they are productive on the floor in the shortest possible time frame.
• Handle escalations and basis analytical skills 
• Provide inputs on process and system to the team members.
• Client Interaction, where required at the level of Supervisors. 
• Ensure compliance with internal policies and procedures, external regulations and information security standards.
• Collect and provide data required for various audits.

 

Ensure that all agents in their process know their goals and how they are linked to the Organization’s quality policy.

Qualifications for Internal Candidates

Graduate with 10+ years of experience in US health insurance claims adjudication and large team handling experience.