Healthcare Processor

Job Description – Healthcare Operations Associate (Health Payer Services)

Position Title

Healthcare Operations Associate - Health Payer Services

Work Location

Work from Office (WFO)

Work Mode

Hybrid Model

Shift Timings

5:00 PM to 2:30 AM IST

Career Level

Level 13

Role Overview

We are seeking detail-oriented and customer-focused professionals to support key healthcare payer operations. The role involves managing member enrollment activities, premium billing, payment application processes, provider demographic maintenance, medical claims processing, and handling provider/member inquiries. The ideal candidate should possess strong analytical skills, accuracy in data processing, and the ability to work effectively in a fast-paced environment while ensuring adherence to quality and compliance standards.

Key Responsibilities

Member Enrollment & Eligibility

• Process member enrollment, maintenance, and eligibility transactions accurately and within defined timelines.
• Review and validate member information to ensure completeness and compliance with payer policies.
• Perform updates, corrections, and changes related to member records.
• Ensure data integrity across healthcare systems and databases.

Premium Billing & Payment Processing

• Support premium billing activities and payment application processes.
• Reconcile billing discrepancies and investigate payment-related issues.
• Process adjustments, refunds, and account updates as required.
• Maintain accurate financial records and documentation.

Provider Data Management

• Update and maintain provider demographic information in the system.
• Verify provider details and ensure accurate record maintenance.
• Support provider onboarding and profile update activities.
• Collaborate with internal stakeholders to resolve provider data issues.

Claims Processing

• Review, validate, and process medical claims according to established guidelines and service-level agreements.
• Identify and investigate claim discrepancies, missing information, or exceptions.
• Ensure compliance with healthcare payer rules, policies, and regulatory requirements.
• Maintain productivity and quality standards while processing transactions.

Customer Service & Issue Resolution

• Respond to provider and member inquiries through designated communication channels.
• Track, investigate, and resolve customer issues in a timely manner.
• Escalate complex cases when necessary while ensuring effective follow-up.
• Deliver a high level of customer satisfaction through professional communication and service.

Quality & Compliance

• Adhere to organizational policies, healthcare regulations, and data privacy requirements.
• Participate in audits, quality reviews, and process improvement initiatives.
• Maintain confidentiality of member and provider information.
• Meet productivity, accuracy, and quality targets.

Required Skills

• Strong analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Attention to detail with high levels of accuracy.
• Ability to manage multiple tasks and meet deadlines.
• Good understanding of customer service principles.
• Proficiency in MS Office applications, especially Excel and Outlook.
• Ability to work effectively in a team environment.

Educational Qualification

Eligible Degrees:

• B.Com
• BBA
• BCA
• BA
• B.Sc
• Any Non-Engineering Bachelor's Degree

Not Eligible:

• BE (Bachelor of Engineering)
• B.Tech (Bachelor of Technology)
• Any Master's Degree (MBA, MCA, M.Tech, M.Sc, MA, M.Com, etc.)

Preferred Qualifications

• Experience in healthcare payer operations, claims processing, enrollment, billing, or customer service will be an added advantage.
• Freshers with strong communication and analytical skills may also be considered.

Additional Information

• Work Mode: Work from Office (Hybrid setup as per business requirements)
• Shift: 5:00 PM to 2:30 AM IST
• Level: 13
• Candidates should be comfortable working in evening/night shifts and in a dynamic healthcare operations environment.

Supplier Notes

• Level 13 Requirement
• Shift Timing: 5:00 PM to 2:30 AM IST
• Work from Office

BE/B.Tech and all Master's Degree candidates are not eligible