Customer Service New Associate, jobs in bangalore
Accenture
Bengaluru, Karnataka
Not provided
Job Description: Job Description:
Responsibilities:
Manages incoming or outgoing telephone calls, eReviews, and/or faxes, including triage, opening of cases and data entry into client system.
Determines contract; verifies eligibility and benefits.
Conducts a thorough provider radius search in client system and follows up with provider on referrals given.
Checks benefits for facility-based treatment.
Obtains intake (demographic) information from caller, eReview and/or from fax. Processes incoming requests, collection of non-clinical information needed for review from providers, utilizing scripts to screen basic and complex requests for pre-certification and/or prior authorization.
Performs data entry of contact into client systems and routes as appropriate
Match fax/clinical records with appropriate case.
Consolidate inputs for approval.
Generate needed letters.
Assign cases/activities and work within client’s system to facilitate workflow and productivity goals.
Refers cases requiring clinical review to a nurse reviewer. Performs case checks and reviews to ensure case creation is complete, correct, and “nurse ready”.
Tasks cases accurately to the correct queue.
Performs Daily Task list maintenance activities under the direction of the Team Lead/Operations Manager and as per customer workflow.
Provide administrative support of post service claims utilizing the member’s benefit contract and health plan guidelines.
Reports inventory numbers and assigns task lists under the direction of the Team Lead/Operations and as requested by the customer.
Prioritize follow up and actions based on case request receipt dates, customer workflow, service level agreements and regulatory timeframes.
Requirements:
Healthcare Utilization Management
Adaptable and flexible
Ability to work well in a team
Commitment to quality
Written and verbal communication
Process-orientation</li
