Process Specialist – Data
2 - 4 Years
Process Quality Specialist/Auditor
ROLE: To audit claims as per the client specific instruction and updated the result in the McKI Database present in the Client Server. He/She is responsible to provide timely feedback to the processor to correct the errors. He/She is respsonsible to log the errors in the specificed decfect tracker. To take the calibration Audit conduct every Month (2nd Wednesday) to reduce the Audit variance between Cognizant and ESI. Also, he/she should take the client clarification call to bridge the process related gaps.
REPORTING TO: Team Leader
ESSENTIAL QUALIFICATION:
* ESSENTIAL SKILLS:
- Any Graduate
- Audit Skill (Eye for an error)
- Analytical, puzzle solving and troubleshooting skills
- Problem Solving skills
- Knowledge of MS Office along with typing skills
* DESIRED SKILLS:
- Prior experience with US Healthcare - Claims / Medical Coding / Medical Billing
- Prior exposure to IT through Education, Training or Work Experience
- Willing to Work in Night Shifts
-
ESSENTIAL SKILLS/PERSONALITY TRAITS:
Good verbal and written communication skills
Leadership skills
Ability to prioritize work
Service excellence oriented
Proactive team player
Analytical and problem solving capabilities
Attention to detail
People management skills & ability to guide and motivate team
Decision making abilities
Achievement orientation
Computer literate
OPERATIONAL RESPONSIBILITY:
Responsible for achieve the epected audit % (as per the sampling Metrics)
Executives should be able to look up to him/her for help, advice and guidance when required
Ensuring team's performance in terms of compliance with SLAs
Setting benchmarks for the team
Reporting to the Team Leader on performance, status and any escalations
PERFORMANCE STANDARDS
MEASURABLE
Establish systems and procedures in the team
Quality audits for grooming and service delivery
Zero error
Customer satisfaction index
Employee motivational index
Punctuality and self-discipline
Inter personal effectiveness
NON MEASURABLE
Self-motivation § Achievement orientation
Relationship building ability
Interface with other departments
Personal grooming and etiquette
Punctuality
Inclination towards being process driven
Going out of the way to satisfy the external customer
Domain Skills
SNo Primary Skill Proficiency Level * Rqrd./Dsrd.
1 Commercial Claims NA Desired
2 Claims NA Desired
Proficiency Legends
Proficiency Level - Generic Reference
PL1 - The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2 - The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3 - The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4 - The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.
ROLE: To audit claims as per the client specific instruction and updated the result in the McKI Database present in the Client Server. He/She is responsible to provide timely feedback to the processor to correct the errors. He/She is respsonsible to log the errors in the specificed decfect tracker. To take the calibration Audit conduct every Month (2nd Wednesday) to reduce the Audit variance between Cognizant and ESI. Also, he/she should take the client clarification call to bridge the process related gaps.
REPORTING TO: Team Leader
ESSENTIAL QUALIFICATION:
* ESSENTIAL SKILLS:
- Any Graduate
- Audit Skill (Eye for an error)
- Analytical, puzzle solving and troubleshooting skills
- Problem Solving skills
- Knowledge of MS Office along with typing skills
* DESIRED SKILLS:
- Prior experience with US Healthcare - Claims / Medical Coding / Medical Billing
- Prior exposure to IT through Education, Training or Work Experience
- Willing to Work in Night Shifts
-
ESSENTIAL SKILLS/PERSONALITY TRAITS:
Good verbal and written communication skills
Leadership skills
Ability to prioritize work
Service excellence oriented
Proactive team player
Analytical and problem solving capabilities
Attention to detail
People management skills & ability to guide and motivate team
Decision making abilities
Achievement orientation
Computer literate
OPERATIONAL RESPONSIBILITY:
Responsible for achieve the epected audit % (as per the sampling Metrics)
Executives should be able to look up to him/her for help, advice and guidance when required
Ensuring team's performance in terms of compliance with SLAs
Setting benchmarks for the team
Reporting to the Team Leader on performance, status and any escalations
PERFORMANCE STANDARDS
MEASURABLE
Establish systems and procedures in the team
Quality audits for grooming and service delivery
Zero error
Customer satisfaction index
Employee motivational index
Punctuality and self-discipline
Inter personal effectiveness
NON MEASURABLE
Self-motivation § Achievement orientation
Relationship building ability
Interface with other departments
Personal grooming and etiquette
Punctuality
Inclination towards being process driven
Going out of the way to satisfy the external customer
Domain Skills
SNo Primary Skill Proficiency Level * Rqrd./Dsrd.
1 Commercial Claims NA Desired
2 Claims NA Desired
Proficiency Legends
Proficiency Level - Generic Reference
PL1 - The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2 - The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3 - The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4 - The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.
Salary: Not Disclosed by Recruiter
Industry:IT-Software / Software Services
Functional Area:ITES, BPO, KPO, LPO, Customer Service, Operations
Role Category:Operations
Role:Process Flow Analyst
Employment Type:Full Time, PermanentCoimbatore
C3 — Chill Special Economic ZoneKeeranatham Village,
Saravanampatti Via,
Coimbatore – 641 035
Tel: +91 422 4251000
+91 422 4293000
Fax: +91 422 3961060
Email: inquiry@cognizant.com
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