Healthcare & Insurance Operations Senior Associate

5 days ago


Chennai, Tamil Nadu, India NTT DATA Global Delivery Services Ltd Full time ₹ 15,00,000 - ₹ 25,00,000 per year

HC & Insurance Operations Senior Assoc.

  • In-depth knowledge and experience in the US healthcare (Non Voice) – Provider Data Validation and Provider Data management.
  • Ability to train the team on new process and process updates.
  • Calibrate with QA's to ensure process knowledge and variance are managed and under control.
  • Ability to create Process SOP, Process Map and identifying the outlier within process.
  • Review Discrepancy report and comments, identify gaps and share with TL.
  • Identify NVA and provide suggestion for automation opportunities.
  • Leads teams to manage day to day inventory
  • Monitors QA scores of production resources and performs reviews to improve overall performance
  • Floor support to operations and 1st point of level of escalation to client in process, inventory, and performance metrics
  • Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
  • Drive team from the front in case of leadership unavailability.
  • Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
  • Ensures day-day transactions are processed per standard operating procedures.
  • Follows Work process flow to ensure pends are completed and maintain Quality and timeliness standards.
  • Knowledge in Amisys and Cenprov application are preferred.
  • Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
  • Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
  • Ability to read and understand the provider contract.
  • Handling Paid claims and recouped claims.
  • Claims Rejections handling.
  • Working in claims denial management.
  • Knowledge about End to End provider billing process.
  • Working knowledge in EDI rejection claims
  • Handing Patient and provider demographic changes.
Experience LevelSenior Level

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