Process Associate

Job description:
Job Description
S No. Details Description
1 JD#
2 Domain Customer Service
3 Category Voice
4 Level 1A –Associate level
5 Educational Qualification Graduate / HSC
6 Experience Worked in service Industry
Experience of 6 months and above desirable.
Experience in call center will be an advantage.
7 Age
8 Communication Skill required Voice Clarity
Accent Neutrality
Fluency in English
Grammar
9 Ability Skill Required (Tech test, Keyboard navigation, Aptitude test, Other domain specific tests) Knowledge of basic computer operations
Willingness to rotate shifts, as needed
Courteous with strong customer service orientation.
Dependable with attention to detail.
Good listening and speaking skills.
Willingness to learn.
Good sales skills.
10 Client mandated test (Contractual) Reference Check (PI)
Culture Fitment Check (PI)
Stability Check (PI)
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Do
Support process by managing transactions as per required quality standards
Fielding all incoming help requests from clients via telephone and/or emails in a courteous manner
Document all pertinent end user identification information, including name, department, contact information and nature of problem or issue
Update own availability in the RAVE system to ensure productivity of the process
Record, track, and document all queries received, problem-solving steps taken and total successful and unsuccessful resolutions
Follow standard processes and procedures to resolve all client queries
Resolve client queries as per the SLA’s defined in the contract
Access and maintain internal knowledge bases, resources and frequently asked questions to aid in and provide effective problem resolution to clients
Identify and learn appropriate product details to facilitate better client interaction and troubleshooting
Document and analyze call logs to spot most occurring trends to prevent future problems
Maintain and update self-help documents for customers to speed up resolution time
Identify red flags and escalate serious client issues to Team leader in cases of untimely resolution
Ensure all product information and disclosures are given to clients before and after the call/email requests
Avoids legal challenges by complying with service agreements
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Deliver excellent customer service through effective diagnosis and troubleshooting of client queries
Provide product support and resolution to clients by performing a question diagnosis while guiding users through step-by-step solutions
Assist clients with navigating around product menus and facilitate better understanding of product features
Troubleshoot all client queries in a user-friendly, courteous and professional manner
Maintain logs and records of all customer queries as per the standard procedures and guidelines
Accurately process and record all incoming call and email using the designated tracking software
Offer alternative solutions to clients (where appropriate) with the objective of retaining customers’ and clients’ business
Organize ideas and effectively communicate oral messages appropriate to listeners and situations
Follow up and make scheduled call backs to customers to record feedback and ensure compliance to contract /SLAs
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Build capability to ensure operational excellence and maintain superior customer service levels of the existing account/client
Undertake product trainings to stay current with product features, changes and updates
Enroll in product specific and any other trainings per client requirements/recommendations
Partner with team leaders to brainstorm and identify training themes and learning issues to better serve the client
Update job knowledge by participating in self learning opportunities and maintaining personal networks
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Deliver
NoPerformance ParameterMeasure1ProcessNo. of cases resolved per day, compliance to process and quality standards, meeting process level SLAs, Pulse score, Customer feedback2Self- ManagementProductivity, efficiency, absenteeism, Training Hours, No of technical training completed
Job Summary
The Provider Service Center Agent acts as the primary liaison between the healthcare payer and its contracted providers. This role is responsible for handling provider inquiries related to claims, eligibility, benefits, authorizations, and provider data while ensuring adherence to US healthcare regulations, payer policies, and service-level agreements (SLAs).
Key Responsibilities
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
Required Qualifications
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
Preferred Qualifications
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
Key Skills & Competencies
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
Performance Metrics
Average Handle Time (AHT)
First Contact Resolution (FCR)
Quality and compliance audit scores
SLA adherence and productivity targets

Work arrangement
No