Job Description

Job Summary

Serve as a customer service specialist for healthcare payer clients resolving complex member and provider inquiries with accuracy and empathy while working hybrid night shifts. Apply strong MS Office skills and solid understanding of HIPAA guidelines to protect sensitive data enhance service quality and support effective claim and benefit issue resolution in a highly regulated workplace.

Responsibilities
- Handle inbound and outbound customer interactions for payer related queries with clear communication and timely resolution while maintaining high service quality in a hybrid night shift environment.
- Document customer contacts case details and resolutions using MS Office tools to maintain accurate records that support audit readiness and continuous service improvement.
- Use spreadsheets and word processing applications to track trends in issues such as claims benefits eligibility and billing so that recurring problems can be identified and reported for process enhancement.




- Apply detailed working knowledge of HIPAA rules in every interaction to safeguard protected health information and reduce the risk of privacy violations and regulatory non compliance.
- Coordinate with internal payer operations teams to research complex claim or policy questions and provide customers with clear explanations that improve understanding and reduce repeat contacts.
- Analyze customer complaints and feedback to pinpoint root causes and propose practical changes that improve first contact resolution and overall service experience for members and providers.
- Follow standard operating procedures and quality checklists for payer processes so that each interaction aligns with contractual service levels and regulatory obligations.
- Use call handling and ticketing systems alongside MS Office to prioritize work queues manage follow ups and ensure that all cases are closed within agreed timelines.
- Collaborate with quality and training teams by sharing

📌 SPE-Customer Service HC (Pune)
🏢 Cognizant Consulting
📍 Pune