Job Description

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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:

About UST HealthProof At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for member. UST HealthProof is run by leaders with strong health plan and technology background with a startup mindset and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth. Claims Examiner UST HealthProof is looking for Claims Examiner, reporting to the Claims Team Leader, the Examiner is responsible for adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding UB04 or CMS1500. Responsible for reviewing claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system\'s claim and line items edits for determination of whether to pay claim/line item(s). As a Claims Examiner at UST HealthProof, this is your opportunity to \xe2\x80\xa2 Be responsible for attending and successfully completing the trainings scheduled by the client and employer \xe2\x80\xa2 Be responsible for processing assigned claims based on client specified guidelines or as directed by team lead \xe2\x80\xa2 Be responsible for meeting claims productivity targets of claims per hour or day as set by team lead \xe2\x80\xa2 Collaborate with other team members on special projects as assigned by the team leads including process documentation, training, quality audit, assist with surge activity for client (s), or any other project as determined by the team lead \xe2\x80\xa2 Develop Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10, UB04, CMS 1500, authorization and other terms, terminology and concepts of healthcare \xe2\x80\xa2 Develop some level of communication with client Claims managers to address issues, concerns and take preventive measures to avoid service quality issues \xe2\x80\xa2 Be responsible for your attendance, time off and reporting shift timings etc. with the prime objective of meeting and exceeding customer deliverables \xe2\x80\xa2 Participate in meetings and project activities outside of the primary location at locations determined by UST management team and team lead You bring: \xe2\x80\xa2 High School degree required with one year of relevant professional experience in Healthcare claims operations for an insurance company or healthcare payor. \xe2\x80\xa2 Willingness to learn new skills and succeed in a new career \xe2\x80\xa2 Excellent verbal and written communication skills. \xe2\x80\xa2 Proficiency with MS Office applications, especially Word and Excel. \xe2\x80\xa2 Team collaborator \xe2\x80\xa2 ICD-9 and ICD-10 coding is a plus, CPT and HCPCS coding, HIPAA is a plus \xe2\x80\xa2 Strong work ethic with ability to multi-task is essential \xe2\x80\xa2 High proficiency in using MS Excel and MS Office Suite \xe2\x80\xa2 Good understanding and ability to analyse claims data and report, SLA, KPI, operations report and present findings in a structured way For this role, we value: \xe2\x80\xa2 The ability to adapt quickly to a fast-paced environment, self-starter and quick learner \xe2\x80\xa2 Excellent written and oral communication skills \xe2\x80\xa2 Team Player and ability to collaborate Overall Experience level: 0-2 years of operation experience, any healthcare Location: Remote

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