A US Healthcare Process Customer Support Executive serves as the primary liaison between US-based patients, healthcare providers, and insurance companies, managing end-to-end administrative, billing, and advantages support.

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Job Overview

- Job Title: Customer Support Executive – US Healthcare Process
- Department: Operations / Customer Experience (International Voice & Blended)
- Shift Timings: Rotational US Shifts (Night Shifts – EST/CST/PST hours)
- Work Mode: On-site (Work from Office)
- Experience Level: 0 to 3 Years (Freshers with exceptional communication or experienced international BPO professionals)

Role Summary

The Customer Support Executive will manage inbound and outbound communications with US healthcare members (patients), physician offices (providers), and insurance carriers. The ideal candidate will navigate complex medical billing inquiries, verify insurance eligibility, process claims, and resolve coverage issues while maintaining strict adherence to HIPAA (Health Insurance Portability and Accountability Act) regulations and quality benchmarks.

Core Responsibilities1. Patient & Member Support (Inbound/Blended)

- Benefits & Eligibility Verification: Explain health insurance policy coverage, co-pays, deductibles, coinsurance, and out-of-pocket maximums to members.
- Billing & EOB Clarification: Assist patients in understanding their medical bills and Explanation of Benefits (EOB) statements, resolving payment discrepancies or out-of-network charges.
- Provider Directory & Scheduling: Help patients locate in-network doctors, specialists, pharmacies, or diagnostic centres, and schedule or reschedule clinical appointments.

2. Provider & Insurance Coordination (Revenue Cycle / Claims)

- Claims Status & Adjudication: Track submitted medical claims, identify reasons for pending or denied claims, and initiate reprocessing or appeals where applicable.
- Prior Authorizations:



Coordinate with healthcare providers and insurance payers to verify or initiate pre-authorizations and referrals for specific medical procedures or prescription medications.
- Accounts Receivable (AR) Follow-up: Conduct outbound calls to insurance carriers to follow up on outstanding claims and ensure timely reimbursement.

3. Compliance, Documentation & Quality

- HIPAA Compliance: Authenticate caller identity diligently and protect Protected Health Information (PHI) and Personally Identifiable Information (PII) across every interaction.
- CRM & EHR Documentation: Log accurate, detailed call notes, disposition codes, and patient demographic updates in Electronic Health Record (EHR) and CRM systems.
- SLA & KPI Adherence: Consistently meet operational targets, including Average Handle Time (AHT), First Call Resolution (FCR), Customer Satisfaction (CSAT), and Quality Audit Scores.

Required Qualifications & Skills

- Education: Minimum 10+2 (Higher Secondary) or Any Graduate degree.
- Communication: Exceptional verbal and written English proficiency with neutral pronunciation, active listening, and high empathy for distressed or elderly callers.
- Domain Knowledge: Basic understanding of the US Healthcare ecosystem, including Medicare, Medicaid, Commercial Insurance, CPT/ICD-10 codes, and Revenue Cycle Management (RCM) is an added advantage.
- Technical Proficiency: Comfortable navigating multiple screens simultaneously, using CRM/EHR tools (e.g., Epic, Cerner, Salesforce), and typing at least 30–35 WPM with 90% accuracy.
- Shift Flexibility: Comfortable working five days a week in night shifts aligned with US time zones, along with rotational weekend offs.

Compensation & Perks

- Salary Package: Competitive fixed CTC plus monthly performance-linked incentives.
- Transport & Meals: Pick-up and drop cab facility (within designated hiring zones) and subsidised night-shift cafeteria services.
- Health & Growth: Comprehensive medical insurance coverage and structured internal job postings (IJPs) for career progression into Quality Analyst (QA), Subject Matter Expert (SME), or Team Lead roles.

Pay: ₹12,500.00 - ₹20,000.00 per month

Benefits:

- Health insurance
- Provident Fund

Work Location: In person

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