Wipro

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.

Job Description

Role Purpose

As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete.

This is a hybrid in office position located in the Tampa Bay, Fl area. You will be required to be in office for the full, 8 week duration of the training. After training is completed you will be on a hybrid schedule. You will have to plan accordinly due to being in office 1-2 times a week.

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Responsibilites

• Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
• Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
• Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
• Data Entry - Enter claim details and maintain accurate records within the claims management system.
• Problem resolution - Investigate discrepancies and resolve disputes related claim processing
• Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.

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• ICD-9 &10 Coding
• Customer Service
• Computer skills with knowledge of Outlook. Word & Excel
• Expert knowledge with a minimum experience of 3 years in Healthcare and claims processing.
• Experience in Govt. Ops with a experience of Medicare and Retirement / Medicaid claims processing.
• Able to explain the terms, Copay, Coinsurance, Deductible and out of pocket.
• Able to describe Medicaid and Medicare eligibility in detail.
• Experience in M&R / Medicaid Rework/Adjustment claims processing preferred.
• Excellent Communication Skills (Verbal & Written)
• CMS 1500 & UB Form Experience is a PLUS!

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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

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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

Mandatory Skills: Claims_Processing .

Expected annual pay for this role ranges from $25,000 to $50,000 . Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.

Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Come to Wipro. Realize your ambitions. Applications from people with disabilities are explicitly welcome.