claims Associate ii - bpmUST Global

Job Description:
Role Proficiency: A Voice Associate should under very minimal guidance be able to take customer support calls effectively and efficiently following the SOPs to complete the process and endeavour to resolve the issue or escalate to a more knowledgeable person to resolve in alignment with SLAs.rnA Data Associate should under very minimal guidance effectively and efficiently process the transactions assigned in a timely manner and ensure that quality of output and accuracy of information is maintained in alignment with SLAs
Outcomes: Acts under very minimal guidance to achieve the following:
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 following 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.
Be aware of any clients processor product updates and ensure 100% compliance towards the same.
Proficient in the process and assist other team members who are new to the process to ensure quick readiness of the team.
Able to handle and manage higher complexity tasks.
Able to analyze processes and come up with ideas to automate them to increase operational efficiency.
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 and tasks completed
Number of non-compliance issues with respect to SOP
Production readiness of new joiners within agreed timelines by providing guidance
Zero/No Client Escalations
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)
Quality: * Perform quality control for transactions processed by associates if required
Reporting: * Create reports
prepare spreadsheets of daily transactions
data entry in software/tool * Report status of tasks assigned
complying with project related reporting standards and process
Productivity: * Completion of tasks with zero errors.
Take steps to improve performance based on coaching
Monitors progress of requests for support and ensures users and other interested parties are kept informed.
Issue Resolution: * Identifies
analyses and solves the incidents/transactions. * Address any problems with the supervisor /QA to ensure maximum productivity and efficiency.
Training: * Attends one on one need-based domain/project/technical trainings as needed.
On time completion of all mandatory training requirements of the organization and customer.
Provide on floor training and one to one mentorship of new joiners.
Escalation: * Escalate problems to appropriate individuals and support team based on established guidelines and procedures.
Manage knowledge: * Consume project related documents
share point
libraries and client universities
Communication: * Share status update to the respective stakeholders and within the team
Collaboration: * Collaborate with different towers of delivery for quick resolution (within SLA); document learnings for self-reference.
Collaborate with other team members for timely resolution of errors
Assist new team members to understand the customer environment.
Process Adherence: * Thorough understanding of organization and customer defined process; consult with mentor when in doubt. Adherence to defined processes.
organization' s policies and business conduct.
Skill Examples: * Customer Focus: Focus on providing 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
Make rule-based decisions and judgments based on guidance from Lead
Analytical ability to understand the larger picture of customer issues.
Ability to follow SOP documents and escalate the alerts with in the SLA defined.
Willingness and ability to learn new skills domain knowledge etc.
Sr. Process Associate Quality Auditor SME
Frontline resource - Voice/Backoffice Quality Auditors SME
Knowledge Examples:
Familiar with Windows Operating Systems MS Word MS Excel.
English comprehension - Reading writing and speaking
Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)
Fair understanding of customer infrastructure ability to co-relate failures.
Familiarity with work allocation and intake functions
Experience level - 2 to 5 years
Additional Comments:
PURPOSE Responsible for the accurate processing and completion of medical claims based defined claims guidelines and policies. Associate can demonstrate proficiency in product lines applicable to the processing unit. RESPONSIBILITIES - Process new claims or modifies existing claims according to the appropriate and applicable action - Analyze claims to determine appropriate action to approve or deny a claim for payment - Determines accurate payment criteria for clearing pending claims based on defined policies and procedures - Researches claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims - Reviewing and addressing provider inquiries regarding claim adjudication - Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process - Demonstrate ability to work on high volume of repetitive claims - Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards QUALIFICATIONS Education - Bachelor's Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession - Credential/Professional Certification related to current work is an advantage Work Experience - Should have 2 to 5 years of medical claims processing experience - Experience with medical coding to include diagnosis coding and terminology is an advantage - Experience in Health rules application is an advantage Skillset - Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols is a must - Ability to multi-task and follow documented claims processes with minimal supervision - Excellent verbal and written business communication skills required - Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel - Strong attention to detail and the ability to make appropriate decisions based on information presented
About Us: 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 our purpose, we partner with our clients from design to operation. Through our nimble approach, we identify their core challenges, and craft disruptive solutions that bring their vision to life. With deep domain expertise and a future-proof philosophy, we embed innovation and agility into our clients' organizations-delivering measurable value and lasting change across industries, and around the world. Together, with over 29,000 employees in 30 countries, we build for boundless impact-touching billions of lives in the process.
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UST Global

Taguig City, Metro Manila
Permanent
Full-time