Associate III | BPM | BPO | Medical Claim adjudication

3 - 5 Years
5 Openings
Chennai

Role description
Role Proficiency:

A Voice Associate Able to independently take customer support calls effectively and efficiently ;follow the SOPs to complete the process and endeavour to resolve the issue handle some escalated issues or escalate to a more knowledgeable person to resolve in alignment with SLAs and assists Lead I – BPM.rnA Data Associate should independently be able to effectively and efficiently process the transactions assigned in timely manner clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained in alignment with SLAs and assists Lead I – BPM.

Outcomes:

Independently achieves the following; guiding other process associates and assists Lead 1 - BPM
Service Level Agreement (SLAs) specified by the client in terms of quality productivity and schedule should be managed to ensure 100% adherence.
Data: Analyze information enter and verify data follow the SOP to ensure completion of the task. Voice: Customer calls responses and any updates or edits to workflow based on after call work should be performed as per directions.
Address performance issues and improvement plans of team and self with supervisor.
Expected to be proficient in the process and domain to ensure quality of transactions and guide the same to the process associates.
Perform QA for production associates as an expert in the function and ensure completion within SLAs.
Create reports on performance metrics for team to manage productivity.
Understand the process and bring forward ideas and solutions to simplify and automate them to increase operational efficiency. Create automation solution and submit the same to Lead I for review.
Measures of Outcomes:

100% Adherence to quality standards
Adherence to turnaround time for response and resolution
Completion of all mandatory training requirements
100% adherence to process and standards
100% adherence to SLAs where applicable
Number of issues fixed/tasks completed
Number of non-compliance issues with respect to SOP
Zero/No Client Escalations
Number of high-quality RCA and QA output
Daily/weekly performance reporting
Mentors A1 and A2 resources on the processes
Outputs Expected:

Processing Data:

Processing transactions assigned as per SOPs


Handling calls Voice:

Handle customer support calls
resolve issues and complete after-call work


Production:

Take calls (voice) or process complex transactions (data)


Issue Resolution:

Address any problems with the supervisor/QA to ensure maximum productivity and efficiency.
Identifies
analyses and solves the incidents/transactions.


Productivity:

Proficient in the process
assisting other team members who are new to the process as well to ensure quick readiness of the team.
Take steps to improve performance based on coaching.
Production readiness of new joiners within agreed timeline by providing guidance Actively participate in the team's or organization wide initiatives
Able to handle and manage higher complexity tasks.


Adherence:

Be aware of any clients process or product updates and ensure 100% compliance towards the same.
Adhere to release management process.
Thorough understanding of organization and customer defined process. Consult with mentor when in doubt.
Adherence to defined processes.
Adhere to organization’ s policies and business conduct.


Reporting:

Create reports on specific SLAs/performance measures/KPIs


Stakeholder Management:

Guide the team in preparing status updates and keep management updated about the status.


Training :

Attends one on one need-based domain/project/technical trainings as needed.
On time completion of all mandatory training requirements of organization and customer.
Provide on floor training and one to one mentorship for new joiners.


Escalation:

Escalate problems to appropriate individuals/support team based on established guidelines and procedures.


Monitoring:

Monitor progress of requests for support and ensures users and other interested parties are kept informed.


Manage knowledge:

Consume project related documents
share point
libraries and client universities


Mentoring:

Mentor and provide guidance to peers and junior associates.
Assist new team members in understanding the customer environment.


Communication:

Status update to the respective stakeholders and within the team


Collaboration:

Collaborate with different towers of delivery for quick resolution (within SLA); document learning's for self-reference.
Collaborate with other team members for timely resolution of errors.
Skill Examples:

Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met.
Attention to detail to ensure SOPs are followed and mistakes are not knowingly made
Team Work: Respect others and work well within the team.
Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)
Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)
Typing Speed with 15WPM and 80% accuracy
Analytical approach: Makes systematic judgments based on information and relevant assumptions.
Ability to follow SOP documents and escalate the s within the defined SLA Willingness and ability to learn new skills domain knowledge etc.
Make rule based and discretionary decisions.
Process Trainer/Sr. QA/Domain Expert/MIS Analyst
Frontline resource - Voice/Backoffice Quality Auditors SME Domain Experts
Knowledge Examples:

Expertise with Windows Operating Systems MS Office tools
English comprehension – Reading writing and speaking
Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)
Familiarity with work allocation and intake functions
Familiarity with quality control processes including pare to analysis and root cause analysis
Knowledge on security policies and tools
Good understanding of customer infrastructure ability to co-relate failures
Experience level – 3 to 7 years

Additional Comments:
Job Description - o Candidates should have minimum 3 years of experience in US healthcare Claims Adjudication, Denial Management and Adjustment process. o Should have worked on both HCFA and UB 04 type claims. o Ability to Analyze and process claims with high degree of quality. o Knowledge on creation of process SOP’s would be an added advantage. o Should have involved on additional activities in Training/Auditing in his current process. o Communication should be proficient. o Able to work on MIS reports through excel and PowerPoint would be a good to have skills.

Skills
Healthcare,Denial Management,Hcfa


About UST
UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.