Job Description

: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.

Mphasis