Level TL

Skill in Claims Adjudication/Document Reviewing processing along with exposure to Chat support operations.

Location – Hyderabad

Shift - US Shift

Notice period – 0-30days

Max CTC – 10LPA

Team Lead on paper (2 years)

: Team Leader - BPO Claims Process

Qualification

- Graduate / Post Graduate preferably MBA graduates
- Knowledge of CRM tools & MS Office tools

Experience:
- 6+ Years

Employee Status:
- Full Time Employee

Shift:
- Rotational Shift

Travel:
- No

Job Location:
- Hyderabad, India

for Team Leader - Claims:

Responsibilities:

- Lead and manage a team of claims adjudicators to ensure timely and accurate processing of claims & Exposure with Chat Processw
- Monitor daily workflow and ensure that claims are processed within the specified TAT and with zero critical errors.
- Oversee transactions for claims submissions, rejections, and payment postings as defined in SOPs.
- Ensure the team stays updated with process knowledge and changes, and contribute to the creation of knowledge updates.
- Review and analyze provider applications for completeness and accuracy.
- Verify and enter updated/additional information from provider applications into the client system.
- Oversee the completion of coding transactions with the required ICD, CPT, and other requirements.
- Ensure complex plans are coded accurately in the system after thorough analysis of source documents.
- Conduct benefit plan analysis and create source documents for coders by reviewing master agreement documents.
- Identify cases eligible for medical reviews and assign them to appropriate reviewers.
- Address any problems identified in the cases for review by reaching out to clients.
- Perform quality control on medical review assessments generated by the medical review process.
- Develop a comprehensive understanding of medical management procedures.
- Provide clear and concise negotiable points based on submitted medical records, identifying necessary medical treatment,



causally related care, response, or lack of response to treatment, etc.
- Identify and address missing records and information necessary for the completion of medical review assessments.
- Adhere to Department of Labour, state, and company timeframe requirements.
- Coordinate physician reviewer referrals as needed and follow up timely to obtain and deliver results.
- Follow up on all pending claims appropriately and initiate the next steps.
- Collaborate with the management team in the ongoing development and implementation of utilization management programs.
- Learn current methods and services as the job requires.
- Advise supervisors of any potential problems as they become evident.
- Manage the teams workload within established performance standards.
- Provide feedback to Team Leads and Managers on the performance of each associate and the team as a whole.
- Maintain and secure confidentiality of client data and all individually identifiable health information accessed through the clients and/or Cognizants systems.
- Coordinate with immediate superiors regarding updates in policies, procedures, process flow, and state requirements.
- Learn new protocols and systems as the job requires.
- Escalate to immediate superiors any unforeseen events or situations beyond assigned tasks and jurisdiction.
- Cross-train on multiple processes.
- Handle difficult and complex transactions with stringent turnaround times and specific requirements.




- Complete missing information in provider details and update the database accordingly for first-time providers and existing provider groups in client systems or databases.

Additional Responsibilities for Team Leader:

- Lead training sessions and workshops to enhance the teams knowledge and skills in claims adjudication.
- Develop and implement best practices for claims management and ensure compliance with industry standards.
- Collaborate with cross-functional teams to improve process efficiency and effectiveness.
- Monitor industry trends and updates to ensure the team is informed of the latest developments in claims adjudication.
- Conduct regular performance reviews and provide constructive feedback to team members.
- Foster a positive and collaborative team environment, encouraging professional growth and development.

Primary Skills: oPrimary SkillProficiency Level *1Managing TeamsPL12Managing ChangePL13Client FocusPL14Effective CommunicationPL15Written CommunicationPL36InnovationPL1Proficiency Legends

Proficiency LevelGeneric ReferencePL1The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.PL2The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.PL3The associate has comprehensive, in-depth and specialized knowledge of the skill. They have extensively demonstrated successful application of the skill in engagements or projects.PL4The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating, and synthesizing solutions using the skill.

Valid PAN Number - _____________________(Why PAN Required > Mandatory to Process Candidature & Find Duplicity in Internal PAN

Validation Process and also to initiate a screening call.

Reach me @

Sonali Chattopadhyay I Associate People Success

Orcapod Consulting Services Pvt Ltd. Email I [email protected] www.orcapodservices.com

(phone hidden)

📌 Team Lead / Claim Adjudication (Hyderabad)
🏢 Orcapod Consulting Services
📍 Hyderabad