Process Associate

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