– Healthcare Operations Associate (Health Payer Services)

Position Title

Healthcare Operations Associate - Health Payer Services

Work Location

Work from Office (WFO)

Work Mode

Hybrid Model

Shift Timings

5:00 PM to 2:30 AM IST

Career Level

Level 13

Role Overview

We 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 strong 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 Responsibilities

Member 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 skilled 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 Qualification

Eligible Degrees:

- B.Com
- BBA
- BCA
- BA
- B.Sc
- Any Non-Engineering Bachelor's Degree

Not 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 strong 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 Office

BE/B.Tech and all Master's Degree candidates are not eligible

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