Job Description

Role Purpose

We are continuing to grow! Come grow with us!!!

Wipro is seeking customer service/claims processors who combine excellent coordination and authorization skills with the ability to function effectively both as part of a team or on an individual basis to bring their talent to our team.

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Primary Responsibilities:

• Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
  Providing excellent customer service, including the ability to handle escalated callers
  Determining authorization or notification requirements
  Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
  Providing administrative approvals (depends on line of business)
  Handling expedited authorizations, authorization updates and status checks
  Confirming member eligibility
  Outreaches to providers and/or Patient to complete authorization requests and prescriptions
  Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
  Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
  Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
  Performs all other related duties as assigned.

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• 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 customers’ and clients’ 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 

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• 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