Health Admin Services Associate-Voice

8129 ASOL - Bangalore 10 SEZ Company; Bengaluru; On-site; INR 350,000 - 550,000; Full time

Job summary

Accenture in Bengaluru is seeking a Health Admin Services Associate to handle claims appeals and administration within healthcare operations. The role involves processing appeals for denied insurance claims, verifying policy criteria and communicating with claimants to resolve cases under regulatory guidelines.

The ideal candidate holds a nursing degree with an active RN license, 1–3 years of relevant experience, strong English communication, and basic computer literacy.

Qualifications

• RN license must be active and unrestricted.
• Graduate with nursing degree or equivalent.
• 1–3 years of experience in healthcare or related BPO/healthcare processes.

Responsibilities

• Solve routine problems largely through precedent and referral to general guidelines.
• Interactions are within your own team and direct supervisor.
• Receive detailed to moderate instruction on daily tasks and new assignments.
• Your decisions impact your own work.
• You will be an individual contributor as part of a team with a focused scope of work.
• Role may require rotational shifts.

Skills

Communication skills

English fluency

Computer literacy

Education

BSN degree

GNMJ Diploma

High School Diploma

Job description

Skill required: Claims Appeals - Claims Administration Designation: Health Admin Services Associate Qualifications:Any Graduation Years of Experience:1 to 3 years

About Accenture Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities. Visit us at www.accenture.com

What would you do?

Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrow. Claims Appeals involves reviewing and processing appeals for denied insurance claims. This includes evaluating the reasons for denial, gathering additional information, and making decisions on the appeal. The goal is to ensure fair and accurate resolution of claims. Responsibilities include communicating with claimants, analyzing documentation, and adhering to regulatory guidelines. This role is essential for maintaining trust and satisfaction in the claims process. Includes the administration of health, life, and property & causality claims. Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.

What are we looking for?

• Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests. Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.


• Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve, request for additional clinical information or summarize and route to Client s nursing reviewer and/or Client s medical staff for review.


• Accurately routes cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefit criteria.


• Responsible for conducting medical management review activities which require the review of clinical information against client specific criteria as noted above but excludes denial determinations.


• Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract. Consult with clinical reviewers and/or U.5.-licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.


• Graduate of any college degree or High School Diploma with 6 months BPO work experience.


• At minimum 6 months of work experience.


• Excellent written and verbal communication skills in English.


• Must pass American English and alternate language fluency test (\\"Test\\") upon hire (non-US resident). For voice accounts, must pass US Berlitz B2 level or Versant score of 58 or any language proficiency equivalence.


• Proficiency in basic computer knowledge with the ability to learn additional computer programs.


• Holds current and unrestricted local Registered Nurse license.


• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNMJ Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma.


• A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required.


• Three months is equivalent to 480 hours of working experience as an RN.

Roles and Responsibilities:

• In this role you are required to solve routine problems, largely through precedent and referral to general guidelines.


• Your expected interactions are within your own team and direct supervisor.


• You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments.


• The decisions that you make would impact your own work.


• You will be an individual contributor as a part of a team, with a predetermined, focused scope of work.


• Please note that this role may require you to work in rotational shifts.

About Accenture

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences.All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law.Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities. Bring your incredible skills and join our global team of innovators. We come together from different backgrounds across the world and work with the latest technologies to create value and growth for our clients. With us, you’ll continue to learn and grow so you can advance in your career. Your personal dreams and ambitions are just as important to us; that’s why we offer support any way we can—when you thrive, we all thrive. Explore your next step at Accenture Belong. Grow. Thrive. Join agreat place to work for reinventors who drive meaningful change for our clients, communities, and the world. Wo rld. Explore your next step at Accenture