Process Associate

Wipro Technologies; Kolkata District; On-site; INR 250,000 - 450,000; Full time

Job summary

Wipro Technologies in India seeks a Providers Service Center Agent to act as the primary liaison between healthcare payers and contracted providers. You will handle inquiries related to claims, eligibility, benefits, authorizations, and provider data while ensuring adherence to US healthcare regulations and SLAs.

The role requires 0–3 years of experience in US healthcare payer or provider services, with strong communication skills and the ability to navigate multiple systems in a fast-paced

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.

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.

Skills

Communication skills

Claims processing

Eligibility knowledge

System navigation

Education

Undergraduate degree

Job description

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 elevate 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

• 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
• 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)
• Quality and compliance audit scores

SLA adherence and productivity targets

Do

• Support process by managing transactions as per required quality standards
  • Fielding all incoming help requests from clients via telephone and/or emails in a courteous manner
  • Document all pertinent end user identification information, including name, department, contact information and nature of problem or issue
  • Update own availability in the RAVE system to ensure productivity of the process
  • Record, track, and document all queries received, problem-solving steps taken and total successful and unsuccessful resolutions
  • Follow standard processes and procedures to resolve all client queries
  • Resolve client queries as per the SLAâÂÂs defined in the contract
  • Access and maintain internal knowledge bases, resources and frequently asked questions to aid in and provide effective problem resolution to clients
  • Identify and learn appropriate product details to facilitate better client interaction and troubleshooting
  • Document and analyze call logs to spot most occurring trends to prevent future problems
  • Maintain and update self-help documents for customers to speed up resolution time
  • Identify red flags and elevate serious client issues to Team leader in cases of untimely resolution
  • Ensure all product information and disclosures are given to clients before and after the call/email requests
  • Avoid legal challenges by complying with service agreements

• Deliver excellent customer service through effective diagnosis and troubleshooting of client queries
  • Provide product support and resolution to clients by performing a question diagnosis while guiding users through step-by-step solutions
  • Assist clients with navigating around product menus and facilitate better understanding of product features
  • Troubleshoot all client queries in a user-friendly, courteous and professional manner
  • Maintain logs and records of all customer queries as per the standard procedures and guidelines
  • Accurately process and record all incoming call and email using the designated tracking software
  • Offer alternative solutions to clients (where appropriate) with the objective of retaining customersâ and clientsâ business
  • Organize ideas and effectively communicate oral messages appropriate to listeners and situations
  • Follow up and make scheduled call backs to customers to record feedback and ensure compliance to contract /SLAs

• Build capability to ensure operational excellence and maintain superior customer service levels of the existing account/client
  • Undertake product trainings to stay current with product features, changes and updates
  • Enroll in product specific and any other trainings per client requirements/recommendations
  • Partner with team leaders to brainstorm and identify training themes and learning issues to better serve the client
  • Update job knowledge by participating in self learning opportunities and maintaining personal networks

Deliver

No Performance Parameter Measure 1 Process No. of cases resolved per day, compliance to process and quality standards, meeting process level SLAs, Pulse score, Customer feedback 2 Self- Management Productivity, efficiency, absenteeism, Training Hours, No of technical training completed

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.

Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.