Customer Support Executive

Job Summary:
We are seeking skilled professionals for the US Healthcare Claims Adjudication – Voice Process role. The candidate will be responsible for handling inbound/outbound calls related to medical claims, ensuring accurate adjudication support, resolving provider/member queries, and maintaining compliance with US healthcare regulations.
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Key Responsibilities:
• Handle inbound and outbound calls with providers, payers, and members regarding claims status and adjudication.
• Review, analyse, and assist in adjudication of medical claims based on policy guidelines.
• Explain claim denials, payment details, and EOBs (Explanation of Benefits) clearly to stakeholders.
• Resolve customer queries related to benefits, eligibility, claim processing, and reimbursement.
• Ensure compliance with HIPAA guidelines and US healthcare regulations.
• Document interactions accurately in the system and update claim records.
• Coordinate with internal teams (non-voice/back-end) for claim resolution and escalations.
• Identify process gaps and suggest improvements to enhance service quality.
• Meet defined quality, productivity, and SLA metrics.
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Required Skills & Qualifications:
Education:
• Any Graduate (preferably Life Sciences, Pharmacy, Nursing, or related field)
Experience:
• 1–5 years in US Healthcare (Claims Adjudication / Voice Process)
• Prior experience in payer or provider domain preferred
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Technical Skills:
• Knowledge of US healthcare concepts:
o Claims Adjudication
o EOBs / ERAs
o CPT, ICD-10, HCPCS codes
o Insurance plans (HMO, PPO, Medicare, Medicaid)
• Familiarity with billing software and CRM tools
• Strong understanding of claims lifecycle

Work arrangement
No