Process Associate

• Handle inbound calls, emails, and portal inquiries from physicians, hospitals, and ancillary providers

• Respond to provider questions on claims status, payment disputes, denials, and adjustments

• Verify member eligibility, benefits, and coverage details across Commercial, Medicare, and Medicaid plans

• Support prior authorization, referral, and utilization management inquiries

• Assist with provider enrollment, credentialing status, demographic updates, and contract-related requests

• Document all interactions accurately in payer systems such as CRM, claims, or provider management platforms

• Ensure strict compliance with HIPAA, CMS, and internal payer policies

• Meet defined SLAs, quality standards, and productivity metrics

• Identify trends, repeat issues, and potential process gaps and escalate when required

• Under Graduate or equivalent education

• 0-3 years of experience in US healthcare payer, provider services, or contact center operations

• Working knowledge of claims processing, eligibility, benefits, and authorization workflows

• Strong verbal and written communication skills

• Ability to navigate multiple systems in a fast-paced environment

• Experience supporting US healthcare payers (Commercial / Medicare / Medicaid)

• Familiarity with CPT, ICD-10, and HCPCS codes

• Exposure to US healthcare regulations including HIPAA and CMS guidelines

• Prior experience with payer systems and provider portals

• Provider-focused customer service

• High attention to detail and documentation accuracy

• Problem-solving and analytical mindset

• Time management and ability to meet SLAs

• Compliance and data privacy awareness

• Team collaboration and adaptability

• Average Handle Time (AHT)

• First Contact Resolution (FCR)

• Quality and compliance audit scores

SLA adherence and productivity targets