Knowledge Specialist

2 weeks ago

Pune, Maharashtra, India Mphasis. Full time

Job titleKnowledge Specialist Band 5 Level 2 Reports toUnit Manager Asst Unit ManagerProvides customer service support for third party administrators Health Maintenance organizations preferred provider organizations managed care organizations and many more in US healthcare insurance market by identifying and updating information The ultimate motive is to ensure commendable service standards and maintain very high customer satisfaction Technical Skills xef x82 xb7 Minimum 1 - 2 years experience in examining and processing Healthcare claims required xef x82 xb7 Medical claims processing experience is a must xef x82 xb7 Provider Maintenance Enrollment experience required xef x82 xb7 Proficiency with computers Process Skills Listed below are the primary job duties and responsibilities that are required xef x82 xb7 Review claims for legitimacy and accuracy xef x82 xb7 Adjudicate claims by approving or denying them according to established guidelines xef x82 xb7 Conducts investigation of pended claims and follow up with respective departments to finalize claims resolution xef x82 xb7 Staying current with knowledge of products processes services offered by the client xef x82 xb7 Review and process medical claims according to guidelines within established turnaround time frames xef x82 xb7 Maintain accurate records notes of claims related documentation xef x82 xb7 Ensure full adherence to all the quality parameters xef x82 xb7 Ensure 100 adherence to schedule xef x82 xb7 Meeting all defined targets like Productivity quality Maintenance of required reports in Excel Behavioral Skills xef x82 xb7 Look up for relevant information and update type into the client systems as per set procedures and policies xef x82 xb7 Attention to detail while accomplishing tasks meeting Weekly Daily targets with required quality in the given timelines xef x82 xb7 Enter updates relating to pertinent healthcare data into the computer system in a timely manner ensuring accuracy completeness and adherence to department procedures xef x82 xb7 Review data for deficiencies or errors correct any incompatibilities if possible xef x82 xb7 Adhere to the team norms for making the overall team a cohesive one xef x82 xb7 Ability to prioritize and manage workload xef x82 xb7 Must be ready to work in night shifts Certification xef x82 xb7 Undergraduate 10 2 Diploma Graduate Only Arts or Science - Non-Technical Only xef x82 xb7 Typing speed 35 to 40 wpm with 95 accuracy without looking at the keyboard xef x82 xb7 Good communication skills Skills PRIMARY COMPETENCY Healthcare PRIMARY SKILL Healthcare-Claims Adjudication PRIMARY SKILL PERCENTAGE 100About Company Mphasis is a leading IT solutions provider offering Applications Business Process Outsourcing BPO and Infrastructure services globally through a combination of technology knowhow domain and process expertise The accolades we have been garnering can be attributed to our undeterred focus in delivering quality solutions across verticals that meet the challenging requirements of our esteemed customers We have been recently felicitated by the economic times as the most distinguished digital company 2015 We have also been ranked 29 of 100 largest financial technology vendors by American Banker and BAI in the FinTech Forward Top 100 rankings

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