Senior Specialist - Provider Control Unit Reviewer

Position Overview

We are seeking a Senior Specialist to join our Provider Control Unit (PCU) team based in Noida. This role requires investigating claim adjudication errors by thoroughly researching provider data across various systems and engaging with provider offices through B2B communications. The specialist will be responsible for maintaining accurate provider records to facilitate smooth claims processing.

Key Duties and Responsibilities

• Analyze claim adjudication failures to identify and resolve discrepancies.
• Investigate provider details using internal platforms and databases.
• Conduct outbound and receive inbound business-to-business calls with providers and their offices.
• Establish, update, and preserve accurate provider information records.
• Verify billing and rendering provider details to ensure correctness.
• Maintain documentation of call results and update system databases accordingly.
• Collaborate with cross-functional internal teams to address claim-related issues.
• Adhere to company guidelines and maintain quality standards throughout processes.

Essential Qualifications and Capabilities

• Excellent verbal and written communication skills in English.
• Proven ability to manage outbound and inbound B2B telephone interactions confidently.
• Strong analytical thinking coupled with effective problem-solving aptitude.
• Proficient computer navigation skills with the capability to handle multiple applications simultaneously.
• Attention to detail and sound decision-making abilities are critical.
• Familiarity with the US Healthcare or Insurance sector is advantageous.
• Ability to work both collaboratively within a team and independently when required.

Additional Information

This position operates on rotational shifts with a five-day workweek requiring office attendance in Noida.

Eligibility

The role is open to candidates holding any bachelor's degree or equivalent in fields such as Business Administration, Management Studies, Literature, Arts, Pharmacy, Music, Architecture, Elementary Education, Vocational Studies, Design, Dental Surgery, Commerce, Hospitality Management, Education, Fine Arts, or Science.