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Associate
2 weeks ago
HR Name :Dhivakar STiming :11 am to 4PmAddress: ELCOT – SEZ Unit -I Special Economic Zone 602/3, Shollinganallur Medavakkam High Road, SholinganallurChennai - 600 119
JD:-Configuration, Member enrolment & Claims
Associate , Senior Associate & SME
0 - 6 Months of experience in US Healthcare and in Benefit Configuration - Benefit coding / Auto Adjudication Set up processes.Experience on Facets tool will be preferedExcellent US Healthcare knowledge in Benefits coding and validationExcellent communication skills and experience in working with US clients directlyAbility to complete the assigned tasks on time, Understand the SLAs and ensure they are met.Ability to coordinate with the Leads and Onshore in work prioritization and able to track and report self-work. Ability to work independently with onshore/offshore team to deliver the assigned projects.Good Analytical and problem-solving skills
1 - 2 Years of experience in US Healthcare and in Benefit Configuration - Benefit coding / Auto Adjudication Set up processes.Experience on Facets tool will be preferedExcellent US Healthcare knowledge in Benefits coding and validationExcellent communication skills and experience in working with US clients directlyAbility to complete the assigned tasks on time, Understand the SLAs and ensure they are met.Ability to coordinate with the Leads and Onshore in work prioritization and able to track and report self-work. Ability to work independently with onshore/offshore team to deliver the assigned projects.Good Analytical and problem-solving skills
3-5 year overall experience in US healthcare plans handling BIM and facets configuration process.Conduct training sessions for new hires and existing team members covering
benefit coding principles, Facets configuration guidelines .Provide hands-on training sessions on the utilization of the Facets system for benefit configurationConduct training needs assessments to identify gaps in knowledge and skills to ensure training thoughputExcellent communication skills with minimum 1 year in training role in payor domainFamiliarity with healthcare policies, regulations, and compliance requirements, such as HIPAA and ACA.Proficiency in different types of health insurance plans, including HMOs, PPOs, and government-sponsored programs like Medicare and Medicaid.Comfortable with a rapidly-changing environmentStay updated with the new trends
Claims :-1 - 2 years experience in US Healthcare Payor operation - handling claims specific to COB,authorization, duplicates, eligibility, and appeals process (UB04 & HCFA 837, NCCI edits)Knowledge with Facets application would be preferred.Good English language skills spoken/written/grammar/sentence formationComfortable using PC and browsingHandling complaints and dispute resolutionTake ownership and follow up to resolveTyping skils @ 25 WPMPlan and schedule audits to review benefit coding and facet configurationDevelop checklist and procedures to systematically conduct audits
Member Enrolment:-
1 - 2 years experience in US Healthcare Payor operation - Broker operation (commission calculation)Knowledge with VUE commissions payment platfrom experience, salesforce application would be preferred.Experience in configuring and maintaining broker systems and commiussion systems data.Management of broker certifications / complianceExperience in US Healthcare payor will be added advantage.Excellent verbal and written communicationAbility to coach other team members and take ownership of escalationsAttention to detail, understand payer and insurance industryCritical thinking.Handling complaints and solving incidents.Experience in broker commissions paymenmt and validationExperience in interacting, researching and responding to broker inquiries
Thanks & RegardsDhivakar SSenior HR-
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