Job Description

The Direct Dropout Claim Specialist plays a pivotal role within Wipro LLC's Business Process Services, tasked with meticulous processing and thorough review of claims to establish eligibility and ensure compliance with operational standards. This position requires a dedicated professional who thrives in a fast-paced environment, excelling both independently and collaboratively to handle critical claim applications and member maintenance activities.

As a key contributor to our claims processing team, the specialist will engage deeply with internal systems, updating and documenting vital information to maintain the integrity and accuracy of member records. Beyond claim adjudication, the role demands adherence to strict quality benchmarks while navigating a dynamic workflow that balances multiple job functions and priorities. This position offers the opportunity to develop expertise in claims processing within the healthcare and insurance domain, contributing directly to superior customer service and operational excellence.

The environment offers a blend of remote and office-based work arrangements, encouraging adaptability and self-management, ensuring the organization's commitment to excellence remains unwavering. Candidates will find this role rewarding for those driven to meet and exceed individual and team-oriented goals, while maintaining professional communication standards and exhibiting a detail-focused approach.

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Responsibilities & Duties

• Collaborate effectively within a team setting and maintain strong partnerships with client stakeholders to optimize claims processing workflows.
• Process claim applications efficiently, determining eligibility criteria with precision and handling all associated member maintenance tasks with timeliness and accuracy.
• Accurately document all relevant information within digital systems, ensuring data integrity and compliance with company policies.
• Consistently meet or exceed production and quality standards regardless of work setting, whether from home or office, emphasizing reliability and accountability.
• Adapt to evolving responsibilities with versatility, occasionally managing multiple tasks simultaneously to support business needs.
• Exhibit exceptional organizational skills, producing high-quality work with close attention to details that affect member outcomes.
• Demonstrate independent decision-making aptitude while maintaining alignment with company guidelines and standards.
• Maintain motivation and drive geared toward surpassing established individual and team performance goals.
• Uphold professional communication across email and chat platforms, with courteous, polite, and energetic interaction at all times.
• Commit to required overtime work when applicable, reflecting dedication to business demands without exceptions.
• Ensure perfect attendance during the initial 90-day onboarding period, underscoring reliability and commitment.
• Conform to the company dress code during office training periods and system setups to present a professional image.

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• Qualifications & Skills
• High School Diploma or GED equivalent is mandatory and will be verified as part of the hiring process.
• Preferred candidates will have at least one year of relevant work experience in data entry, claims processing, or backend operational roles.
• Previous experience in claims adjudication or customer service is advantageous but not a strict requirement.
• Strong analytical skills with the ability to read, interpret, and solve problems effectively are essential for success in this role.
• Proficiency with computers, including understanding basic hardware connections such as USB and cable management, is required.
• Excellent verbal and written communication skills are vital for clear and consistent interaction with team members and clients.
• Typing speed should meet a minimum threshold of 30 words per minute with 90% accuracy, ensuring efficiency and precision in data entry tasks.
• Applicants must be capable of providing complete and accurate paperwork for background verification processes.
• Demonstrated knowledge of business operations and familiarity with relevant operational platforms will be beneficial.