Job Description
Job Description
Job title Transaction Processing Officer (Band 5, Level 2)
Reports to Unit Manager / Asst Unit Manager
Provides 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
Minimum One (1) year experience in examining and processing Healthcare claims required.
Medical claims processing experience is a must.
Provider Maintenance, Enrollment Experience Required.
Proficiency with computers.
Process Skills
Listed below are the primary job duties and responsibilities that are required:
Primary responsibility is to key claim details from claim images into the healthcare software.
Staying current with knowledge of products/ processes & services offered by the client.
Review and process medical claims according to guidelines within established turnaround time frames
Review claims for legitimacy and accuracy
Adjudicate claims by approving or denying them according to established guidelines.
Conducts investigation of pended claims and follow up with respective departments to finalize claims resolution.
Maintain accurate records/notes of claims related documentation.
Ensure full adherence to all the quality parameters.
Ensure 100% adherence to schedule.
Meeting all defined targets like Productivity, quality, Maintenance of required reports in Excel.
Behavioral Skills
Look up for relevant information and update (type into) the client systems as per set procedures and policies.
Attention to detail while accomplishing tasks, meeting Weekly / Daily targets with required quality in the given timelines,
Enter updates relating to pertinent healthcare data into the computer system in a timely manner ensuring accuracy, completeness, and adherence to department procedures.
Review data for deficiencies or errors, correct any incompatibilities if possible.
Adhere to the team norms for making the overall team a cohesive one.
Ability to prioritize and manage workload.
Must be ready to work in night shifts,
Certification
Undergraduate (10+2)/Diploma / Graduate (Only Arts or Science) – Non-Technical Only
Typing speed 35 to 40 wpm with +5% accuracy (without looking at the keyboard)
Good communication skills
Job title Transaction Processing Officer (Band 5, Level 2)
Reports to Unit Manager / Asst Unit Manager
Provides 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
Minimum One (1) year experience in examining and processing Healthcare claims required.
Medical claims processing experience is a must.
Provider Maintenance, Enrollment Experience Required.
Proficiency with computers.
Process Skills
Listed below are the primary job duties and responsibilities that are required:
Primary responsibility is to key claim details from claim images into the healthcare software.
Staying current with knowledge of products/ processes & services offered by the client.
Review and process medical claims according to guidelines within established turnaround time frames
Review claims for legitimacy and accuracy
Adjudicate claims by approving or denying them according to established guidelines.
Conducts investigation of pended claims and follow up with respective departments to finalize claims resolution.
Maintain accurate records/notes of claims related documentation.
Ensure full adherence to all the quality parameters.
Ensure 100% adherence to schedule.
Meeting all defined targets like Productivity, quality, Maintenance of required reports in Excel.
Behavioral Skills
Look up for relevant information and update (type into) the client systems as per set procedures and policies.
Attention to detail while accomplishing tasks, meeting Weekly / Daily targets with required quality in the given timelines,
Enter updates relating to pertinent healthcare data into the computer system in a timely manner ensuring accuracy, completeness, and adherence to department procedures.
Review data for deficiencies or errors, correct any incompatibilities if possible.
Adhere to the team norms for making the overall team a cohesive one.
Ability to prioritize and manage workload.
Must be ready to work in night shifts,
Certification
Undergraduate (10+2)/Diploma / Graduate (Only Arts or Science) – Non-Technical Only
Typing speed 35 to 40 wpm with +5% accuracy (without looking at the keyboard)
Good communication skills
💡 Quick Summary
Seeking a career-building opportunity? The Transctn Procng Offcr position is now open for candidates interested in the Customer Care sector. This role in Pune offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Customer Care is a plus.
