Job Description

The Customer Support Agent will be responsible for handling US health insurance Claims from healthcare providers or their authorized representatives. The Agent will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines.



Key Responsibility



Handles Claims related to providers:



Benefits, eligibility, claim status, Claims adjudication



Claim research and Explanation of Benefits (EOB)



Utilize internal systems and tools (via secure access methods) to retrieve and update information.



Document all the daily tasks related to Claims adjudicated in the system.



Escalate unresolved cases to the appropriate internal departments.



Communicate clearly, concisely, and professionally with customer.



Adhere to all privacy laws and regulatory compliance requirements related to CMS and HIPAA.



Meet performance targets and service level agreements (SLAs).



Required Qualification



High school diploma or equivalent (mandatory)



Some college education or a completed degree (preferred)



Strong command of the English language (verbal and written)



Basic knowledge of Windows OS and Microsoft Office tools



Required Experience

2-5 years of Claims Adjudication (preferably in healthcare or insurance)



Experience working in office environment with US healthcare background



Familiarity with claims processing systems and provider portals (preferred)



Experience on Medicare plans especially on I-SNP will be an added advantage.



Clear knowledge on different types of facilities in US healthcare like SNF, NF etc.,



Required Experience



2-5 years of Claims Adjudication (preferably in healthcare or insurance)



Experience working in office environment with US healthcare background



Familiarity with claims processing systems and provider portals (preferred)



Experience on Medicare plans especially on I-SNP will be an added advantage.



Clear knowledge on different types of facilities in US healthcare like SNF, NF etc.,



Behavioral Attributes



Empathy: Understands and acknowledges provider concerns



Professionalism: Maintains a calm and respectful tone under pressure



Accountability: Takes ownership of responsibilities and outcomes



Adaptability: Flexible with process changes and system updates



Confidentiality: Complies with data privacy standards and regulations



Competency



Excellent Communication: Ability to articulate clearly and listen actively



Problem Solving: Uses logic and reasoning to resolve issues effectively



Technical Proficiency: Comfortable navigating multiple systems and platforms



Time Management: Handles tasks efficiently while meeting deadlines



Customer Centricity: Focused on delivering a positive provider experience



Team Collaboration: Works well with others and contributes to team success

Qualifications

Range of Year Experience-Min Year

Range of Year Experience-Max Year