Job DescriptionJob Description – Healthcare Operations Associate (Health Payer Services)Position TitleHealthcare Operations Associate - Health Payer ServicesWork LocationWork from Office (WFO)Work ModeHybrid ModelShift Timings5:00 PM to 2:30 AM ISTCareer LevelLevel 13Role OverviewWe are seeking detail-oriented and customer-focused professionals to support key healthcare payer operations. The role involves managing member enrollment activities, premium billing, payment application processes, provider demographic maintenance, medical claims processing, and handling provider/member inquiries. The ideal candidate should possess robust analytical skills, accuracy in data processing, and the ability to work effectively in a fast-paced environment while ensuring adherence to quality and compliance standards.Key ResponsibilitiesMember Enrollment & Eligibility- Process member enrollment, maintenance, and eligibility transactions accurately and within defined timelines.- Review and validate member information to ensure completeness and compliance with payer policies.- Perform updates, corrections, and changes related to member records.- Ensure data integrity across healthcare systems and databases.Premium Billing & Payment Processing- Support premium billing activities and payment application processes.- Reconcile billing discrepancies and investigate payment-related issues.- Process adjustments, refunds, and account updates as required.- Maintain accurate financial records and documentation.Provider Data Management- Update and maintain provider demographic information in the system.- Verify provider details and ensure accurate record maintenance.- Support provider onboarding and profile update activities.- Collaborate with internal stakeholders to resolve provider data issues.Claims Processing- Review, validate, and process medical claims according to established guidelines and service-level agreements.- Identify and investigate claim discrepancies, missing information,



or exceptions.- Ensure compliance with healthcare payer rules, policies, and regulatory requirements.- Maintain productivity and quality standards while processing transactions.Customer Service & Issue Resolution- Respond to provider and member inquiries through designated communication channels.- Track, investigate, and resolve customer issues in a timely manner.- Escalate complex cases when necessary while ensuring effective follow-up.- Deliver a high level of customer satisfaction through professional communication and service.Quality & Compliance- Adhere to organizational policies, healthcare regulations, and data privacy requirements.- Participate in audits, quality reviews, and process improvement initiatives.- Maintain confidentiality of member and provider information.- Meet productivity, accuracy, and quality targets.Required Skills- Strong analytical and problem-solving abilities.- Excellent verbal and written communication skills.- Attention to detail with high levels of accuracy.- Ability to manage multiple tasks and meet deadlines.- Good understanding of customer service principles.- Proficiency in MS Office applications, especially Excel and Outlook.- Ability to work effectively in a team environment.Educational QualificationEligible Degrees:- B.Com- BBA- BCA- BA- B.Sc- Any Non-Engineering Bachelor's DegreeNot Eligible:- BE (Bachelor of Engineering)- B.Tech (Bachelor of Technology)- Any Master's Degree (MBA, MCA, M.Tech, M.Sc, MA, M.Com, etc.)Preferred Qualifications- Experience in healthcare payer operations, claims processing, enrollment, billing, or customer service will be an added advantage.- Freshers with robust communication and analytical skills may also be considered.Additional Information- Work Mode: Work from Office (Hybrid setup as per business requirements)- Shift: 5:00 PM to 2:30 AM IST- Level: 13- Candidates should be comfortable working in evening/night shifts and in a dynamic healthcare operations environment.Supplier Notes- Level 13 Requirement- Shift Timing: 5:00 PM to 2:30 AM IST- Work from OfficeBE/B.Tech and all Master's Degree candidates are not eligible

📌 Healthcare Processor (Chennai)
🏢 Artech Infosystems Private
📍 Chennai