Job Description

The Production Agent L1, operating under the title Healthcare Pre-Auth Specialist at Wipro LLC, plays a key role within the BPS-HLS P&P sector to ensure effective clinical coverage review and prior authorization processing. This position is integral to supporting healthcare providers and members by facilitating authorization verification, referral validation, and clinical case management. The role requires thorough assessment to decide whether prior authorization can be granted based on established guidelines or if cases warrant further clinical review, thus safeguarding compliance and quality of care delivery.

In this capacity, you will be responsible for managing case intake, coordinating communication with providers and members, and documenting all case activities with precision and attention to detail. Your work will contribute directly to streamlining healthcare operations, reducing processing times, and maintaining high standards that align with regulatory requirements and company policies. This function is critical in enabling clinicians to focus on patient care while ensuring operational efficiency in authorization processes.

Beyond the day-to-day tasks, the role encourages continuous learning and adaptation to evolving healthcare policies and technologies. It offers a dynamic work environment where proactivity, problem-solving skills, and a commitment to quality are highly valued. By joining Wipro, you become part of a forward-thinking team dedicated to transforming healthcare services through innovation and expert human support.

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Primary Responsibilities:

• Maintain a consistent production output while meeting or exceeding quality, accuracy, and compliance standards set by regulatory bodies and internal protocols.
• Accurately establish and document cases in the case management system ensuring all necessary information is complete and verifiable.
• Conduct thorough review and careful research of each case to determine eligibility for prior authorization or the need for advanced clinical review.
• Employ critical thinking and resourcefulness to resolve complex issues independently, utilizing available tools such as medical policies, operating procedures, and knowledge databases.
• Conduct timely outbound communications with healthcare providers and members to acquire necessary information regarding authorizations, referrals, or case specifics.
• Coordinate closely with healthcare providers to arrange treatment schedules for members, ensuring smooth care continuity and member satisfaction.
• Collaborate with team members, managers, and directors to accommodate additional duties as required, contributing positively to team objectives and organizational goals.

This role is performance-driven and requires adaptability and strong organizational skills to manage multiple tasks effectively in a fast-paced healthcare environment.

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Qualifications Required:

• High School Diploma or GED is the minimum educational requirement; additional educational credentials or certifications related to healthcare administration or medical office support are beneficial.
• At least one year of professional experience in an office setting, with prior exposure to healthcare environments preferred, demonstrating ability to manage clerical and administrative responsibilities.
• Customer service experience is essential, particularly involving outbound calling to members, providers, or other stakeholders.
• Proficiency in computer operations is mandatory; candidates should be comfortable navigating multiple software applications and digital tools.
• Strong command of Microsoft Office suite, including Outlook for composing and managing emails, Word for document creation, and Excel for handling data spreadsheets efficiently.
• Flexibility to work an eight-hour shift scheduled Monday through Friday between 7am and 7pm; options for Tuesday-Saturday or Sunday-Thursday shifts may be available to meet business demands.
• Willingness to occasionally work outside standard business hours in response to operational needs is expected.
• Ability to independently troubleshoot and set up computer equipment within a secured work-from-home environment that protects Protected Health Information (PHI) and Personally Identifiable Information (PI) in accordance with company policies.
• Applicants must have an approved designated workspace within a UnitedHealth Group office or own a home workspace with access to reliable, dedicated hard-wired high-speed internet connection (minimum 1.5 Mbps download and 1 Mbps upload speeds). In rare cases, manager approval allows use of local internet providers with reimbursement eligibility.

Preferred Qualifications:

• Experience with back-office medical platforms, prior authorization systems, or healthcare information management systems enhances job performance.
• Knowledge of healthcare industry practices, including familiarity with hospital operations, physician office settings, medical terminology, ICD-10 and CPT coding, Medicare, and Medicaid services is advantageous.
• Background in clerical or administrative support roles within healthcare contributes positively to managing complex case workloads.
• Demonstrated ability to rapidly learn and adapt to new computer systems or specialized software applications is highly valuable.

Wipro LLC fosters an inclusive and diverse work environment, encouraging applicants from varied backgrounds, including veterans and individuals with disabilities, to apply. The company provides comprehensive benefits and supports professional development, underpinning a workplace culture rooted in respect, growth, and opportunity.