International Voice Process Agent Claims

Job Description – Healthcare Claims Customer Support (US Healthcare)

Role Summary

We are seeking a detail-oriented and customer-focused professional to assist healthcare providers and hospitals with queries related to claims submission, claim status, and patient-related inquiries. The role requires strong knowledge of the US healthcare system, claims adjudication, and call center operations.

Key Responsibilities

• Act as the primary point of contact for providers and hospitals regarding:
• Claim submission issues
• Claim status updates
• Payment discrepancies
• Patient-related inquiries
• Analyze and resolve claim-related queries by reviewing claim details and payer responses.
• Provide accurate information on claim adjudication outcomes, including denials, rejections, and approvals.
• Ensure compliance with US healthcare regulations including HIPAA guidelines while handling sensitive patient information.
• Maintain high levels of customer satisfaction through effective communication and timely resolution.
• Document all interactions accurately in internal systems.
• Collaborate with internal teams (billing, coding, QA) to ensure issue resolution.
• Meet and exceed call center performance metrics.

Eligibility Criteria / Experience Requirements

• Minimum 1+ years of experience in BPO environment.
• Prior experience in US Healthcare domain is mandatory.
• Experience handling voice and/or non-voice processes (candidates with non-voice experience but strong communication skills are encouraged).

Required Skills & Knowledge

Domain Knowledge

• Strong understanding of Claims Adjudication Process, including:
• Claim lifecycle (submission → processing → adjudication → payment)
• Denials and appeals
• EOB (Explanation of Benefits) interpretation
• Knowledge of:
• Medicare & Medicaid policies
• Group & Commercial insurance plans
• Familiarity with healthcare laws:
• HIPAA (Health Insurance Portability and Accountability Act)
• ACA (Affordable Care Act)

Call Center & Operational Skills

• Good understanding of key performance metrics:
• AHT (Average Handle Time)
• ASA (Average Speed of Answer)
• FCR (First Call Resolution)
• CSAT (Customer Satisfaction Score)
• NPS (Net Promoter Score)
• Schedule Adherence
• Ability to manage workload in a high-volume, fast-paced environment.

Soft Skills

• Excellent communication skills (verbal & written)
• Strong problem-solving and analytical abilities
• Customer-centric mindset
• Attention to detail
• Ability to work independently and as part of a team

Work Requirements

• Willingness to work in rotational shifts
• Flexible with rotational week-offs

Preferred Qualifications

• Prior experience in claims processing or provider support
• Exposure to healthcare payer systems or billing platforms