For Medical Management Bachelor’s degree in Nursing or any health science related field.
For NA High School Equiv.
Responsibility:

Business / Customer:

Data Processes:

:

Efficiently Process predefined number of transactions as assigned with highest level of accuracy as agreed upon by the client.
Provide highest level of customer satisfaction.
Strive to understand and resolve issues/queries at the first instant.
Maintain the business controls as per the requirement.
Articulate/ communicate in a manner which is understood by clients / endusers.
Connect & provide highest level of satisfaction to the customer.
For Member Management:

Generate clientspecified reports relating to operations.
Respond to data requests and other inquiries from the client.
Release WCUM determinations to claim stakeholders following clientestablished protocols.
Identify the medical flags in the client system.
Provide reports and other data requests specified by the client.
Serve as first level contact for customer complaint resolution.
Provide reports and other data requests specified by the client.
For NA:

Take ownership of delivery including any customer communication and handle queries / clarifications from the customer.
Voice Processes:

:

For Claims, RCM, Provider Services and Member Services:

Make and Answer calls to and from customers/end users based on agreed time frames.
Transfer calls involving next level of service to the appropriate department as per the given guidelines.