Job Description

JOB DESCRIPTION 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: POSITION DESCRIPTION Appeals and Grievances Intake Analyst Who we are: 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 start up 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. Job Summary: UST HealthProof is searching for an Appeals and Grievances Intake Analyst who will support coordination of appeals and grievances intake, requesting medical records, and member/provider requests. Promotes and supports Appeals and Grievances team as required. As an Appeals and Grievances Analyst at UST HealthProof, this is your opportunity to: . Provide support services to team members triaging and completing intake requests for appeals and grievances into a system. . Requesting medical records or other documentation as needed to complete appeal and grievances. . Maintain accurate and complete documentation of required information that meets quality standards. . Protect the confidentiality of the member information and adheres to the company policies regarding confidentiality. . Perform other duties as assigned. You bring: . High school diploma or G.E.D. required. Associate or bachelor\'s degree in health care related field is preferred. Current unrestricted LPN license or certified Medical Assistant designation preferred. . Minimum of one year experience in a health care related field. Preferred setting is hospital, medical doctor\'s office, or health insurance company. Appeal and grievance experience preferred. . Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or the insurance industry is required. . Computer literacy to include Microsoft Office products, . Advanced technical skills for use of hardware and software with a high degree of accuracy. . Excellent oral and written communication skills for representation of clear and concise results. . Ability to manage significant workload, and to work efficiently under pressure, meeting established deadlines with minimal supervision. . Strong time management skills. . Must possess high degree of accuracy, efficiency, and dependability. . Effective written and verbal communication and feedback. . Effective organizational skills with ability to be flexible and prioritize tasks. . Knowledge of educational assessments and learning strategies. . Must be knowledgeable of and able to use standard, basic grammar, punctuation, and spelling.

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