Job Description

Accountabilities:

The Healthcare Support Representative will play a critical role in managing healthcare member and provider interactions while supporting claims operations and service improvements.

• Handle inbound and outbound member and provider inquiries through phone, email, and chat channels with professionalism, empathy, and efficiency.
• Provide accurate guidance on benefits, eligibility, coverage details, claims status, prior authorizations, billing questions, reimbursement policies, and provider support processes.
• Research, process, and resolve healthcare claims issues, including adjustments, denials, appeals, discrepancies, payment concerns, and overpayment reviews.
• Verify coverage requirements, eligibility information, and documentation accuracy while following established healthcare workflows and compliance standards.
• Conduct follow-ups with members and providers to ensure timely resolution, satisfaction, and continuity of service.
• Maintain accurate documentation of interactions, claims activities, and operational procedures.
• Support provider outreach activities, including documentation collection, data updates, and claim resolution efforts.
• Collaborate with internal teams and external partners to address complex cases and improve operational processes.
• Identify recurring issues, recommend improvements, and contribute to quality assurance and workflow optimization initiatives.
• Maintain confidentiality and compliance with healthcare regulations, including HIPAA and other applicable standards.

Requirements:

The ideal candidate will have experience in healthcare operations, customer support, and/or claims management, with strong communication skills and the ability to manage detailed processes in a fast-paced environment.

• 3–5 years of experience in a healthcare payer, third-party administrator (TPA), health insurance, claims operations, or healthcare contact center environment.
• Strong understanding of healthcare insurance concepts, benefits, eligibility, medical terminology, and claims lifecycle management.
• Excellent English verbal and written communication skills with a service-oriented and empathetic approach.
• Strong analytical thinking, problem-solving abilities, attention to detail, and sound judgment.
• Ability to manage multiple priorities while maintaining accuracy and professionalism in a digital-first work environment.
• Experience using Microsoft Office Suite and customer service, claims processing, or healthcare administration systems.
• Experience with payer portals, EDI standards, CRM platforms, or healthcare technology tools is preferred.
• Familiarity with claims types such as facility, DME, behavioral health, or high-cost claims is an advantage.
• Knowledge of payment integrity, provider relations, medical billing, consolidated billing platforms, or alternative payment models is a plus.
• Associate or bachelor’s degree in healthcare administration, business, or a related field is preferred.
• Ability to support USA contact center operating hours and participate in a rotating on-call schedule when required.

Benefits:

• Competitive compensation package based on experience, qualifications, and relevant certifications.
• Salary range of ₹500,000 - ₹1,500,000 INR.
• Remote work opportunity.
• Opportunity to contribute to healthcare transformation initiatives within a growing, technology-driven environment.
• Exposure to diverse healthcare operations, claims management, and member advocacy functions.
• Collaborative workplace focused on innovation, continuous improvement, and professional growth.
• Inclusive environment that values diversity and equal opportunity.