Role Proficiency:

A Voice Associate Able to independently take customer support calls effectively and efficiently ;follow the SOPs to complete the process and endeavour to resolve the issue handle some escalated issues or escalate to a more knowledgeable person to resolve in alignment with SLAs and assists Lead I – BPM.rnA Data Associate should independently be able to effectively and efficiently process the transactions assigned in timely manner clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained in alignment with SLAs and assists Lead I – BPM.

Outcomes:

Independently achieves the following; guiding other process associates and assists Lead 1 - BPM      Service Level Agreement (SLAs) specified by the client in terms of quality productivity and schedule should be managed to ensure 100% adherence.      Data: Analyze information enter and verify data follow the SOP to ensure completion of the task. Voice: Customer calls responses and any updates or edits to workflow based on after call work should be performed as per directions.      Address performance issues and improvement plans of team and self with supervisor.      Expected to be proficient in the process and domain to ensure quality of transactions and guide the same to the process associates.      Perform QA for production associates as an expert in the function and ensure completion within SLAs.      Create reports on performance metrics for team to manage productivity.      Understand the process and bring forward ideas and solutions to simplify and automate them to increase operational efficiency. Create automation solution and submit the same to Lead I for review.

Measures of Outcomes:

     100% Adherence to quality standards      Adherence to turnaround time for response and resolution      Completion of all mandatory training requirements      100% adherence to process and standards      100% adherence to SLAs where applicable      Number of issues fixed/tasks completed      Number of non-compliance issues with respect to SOP      Zero/No Client Escalations      Number of high-quality RCA and QA output   Daily/weekly performance reporting Mentors A1 and A2 resources on the processes

Outputs Expected:

Processing Data:

Processing transactions assigned as per SOPs

Handling calls Voice:

Handle customer support calls
resolve issues and complete after-call work

Production:

Take calls (voice) or process complex transactions (data)

Issue Resolution:

Address any problems with the supervisor/QA to ensure maximum productivity and efficiency. Identifies
analyses and solves the incidents/transactions.

Productivity:

Proficient in the process
assisting other team members who are new to the process as well to ensure quick readiness of the team. Take steps to improve performance based on coaching. Production readiness of new joiners within agreed timeline by providing guidance Actively participate in the team's or organization wide initiatives Able to handle and manage higher complexity tasks.

Adherence:

Be aware of any clients process or product updates and ensure 100% compliance towards the same. Adhere to release management process. Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization’ s policies and business conduct.

Reporting:

Create reports on specific SLAs/performance measures/KPIs

Stakeholder Management:

Guide the team in preparing status updates and keep management updated about the status.

Training :

Attends one on one need-based domain/project/technical trainings as needed. On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one to one mentorship for new joiners.

Escalation:

Escalate problems to appropriate individuals/support team based on established guidelines and procedures.

Monitoring:

Monitor progress of requests for support and ensures users and other interested parties are kept informed.

Manage knowledge:

Consume project related documents
share point
libraries and client universities

Mentoring:

Mentor and provide guidance to peers and junior associates. Assist new team members in understanding the customer environment.

Communication:

Status update to the respective stakeholders and within the team

Collaboration:

Collaborate with different towers of delivery for quick resolution (within SLA); document learning's for self-reference. Collaborate with other team members for timely resolution of errors.

Skill Examples:

     Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met.      Attention to detail to ensure SOPs are followed and mistakes are not knowingly made      Team Work: Respect others and work well within the team.      Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)      Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)      Typing Speed with 15WPM and 80% accuracy      Analytical approach: Makes systematic judgments based on information and relevant assumptions.      Ability to follow SOP documents and escalate the s within the defined SLA Willingness and ability to learn new skills domain knowledge etc.      Make rule based and discretionary decisions.   Process Trainer/Sr. QA/Domain Expert/MIS Analyst   Frontline resource - Voice/Backoffice Quality Auditors SME Domain Experts

Knowledge Examples:

     Expertise with Windows Operating Systems MS Office tools      English comprehension – Reading writing and speaking      Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)      Familiarity with work allocation and intake functions      Familiarity with quality control processes including pare to analysis and root cause analysis      Knowledge on security policies and tools      Good understanding of customer infrastructure ability to co-relate failures      Experience level – 3 to 7 years

Additional Comments:

Job Description - Appeals and Grievances Intake Analyst Who we are: At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for member. UST HealthProof is run by leaders with strong health plan and technology background with a start up mindset and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth. Job Summary: UST HealthProof is searching for an Appeals and Grievances Intake Analyst who will support coordination of appeals and grievances intake, requesting medical records, and member/provider requests. Promotes and supports Appeals and Grievances team as required. As an Appeals and Grievances Analyst at UST HealthProof, this is your opportunity to: • Provide support services to team members triaging and completing intake requests for appeals and grievances into a system. • Requesting medical records or other documentation as needed to complete appeal and grievances. • Maintain accurate and complete documentation of required information that meets quality standards. • Protect the confidentiality of the member information and adheres to the company policies regarding confidentiality. • Perform other duties as assigned. You bring: • High school diploma or G.E.D. required. Associate or bachelor’s degree in health care related field is preferred. Current unrestricted LPN license or certified Medical Assistant designation preferred. • Minimum of one year experience in a health care related field. Preferred setting is hospital, medical doctor’s office, or health insurance company. Appeal and grievance experience preferred. • Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or the insurance industry is required. • Computer literacy to include Microsoft Office products, • Advanced technical skills for use of hardware and software with a high degree of accuracy. • Excellent oral and written communication skills for representation of clear and concise results. • Ability to manage significant workload, and to work efficiently under pressure, meeting established deadlines with minimal supervision. • Strong time management skills. • Must possess high degree of accuracy, efficiency, and dependability. • Effective written and verbal communication and feedback. • Effective organizational skills with ability to be flexible and prioritize tasks. • Knowledge of educational assessments and learning strategies. • Must be knowledgeable of and able to use standard, basic grammar, punctuation, and spelling.