Associate II - BPM

Role Proficiency:

A Voice Associate should under very minimal guidance be able to take customer support calls effectively and efficiently following the SOPs to complete the process and endeavour to resolve the issue or escalate to a more knowledgeable person to resolve in alignment with SLAs.rnA Data Associate should under very minimal guidance effectively and efficiently process the transactions assigned in a timely manner and ensure that quality of output and accuracy of information is maintained in alignment with SLAs

Outcomes:

Acts under very minimal guidance to achieve the following:

• 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 following 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.

• Be aware of any clients processor product updates and ensure 100% compliance towards the same.

• Proficient in the process and assist other team members who are new to the process to ensure quick readiness of the team.

• Able to handle and manage higher complexity tasks.

• Able to analyze processes and come up with ideas to automate them to increase operational efficiency.
  
  

  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 and tasks completed

  • Number of non-compliance issues with respect to SOP

  • Production readiness of new joiners within agreed timelines by providing guidance

  • Zero/No Client Escalations
    
  
  

  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)
  
  Quality:
  • Perform quality control for transactions processed by associates if required
  
  Reporting:
  • Create reports
    prepare spreadsheets of daily transactions
    data entry in software/tool
    

  • Report status of tasks assigned
    complying with project related reporting standards and process
  
  Productivity:
  • Completion of tasks with zero errors.
    

  • Take steps to improve performance based on coaching
    

  • Monitors progress of requests for support and ensures users and other interested parties are kept informed.
  
  Issue Resolution:
  • Identifies
    analyses and solves the incidents/transactions.
    

  • Address any problems with the supervisor /QA to ensure maximum productivity and efficiency.
  
  Training:
  • Attends one on one need-based domain/project/technical trainings as needed.
    

  • On time completion of all mandatory training requirements of the organization and customer.
    

  • Provide on floor training and one to one mentorship of new joiners.
  
  Escalation:
  • Escalate problems to appropriate individuals and support team based on established guidelines and procedures.
  
  Manage knowledge:
  • Consume project related documents
    share point
    libraries and client universities
  
  Communication:
  • Share status update to the respective stakeholders and within the team
  
  Collaboration:
  • Collaborate with different towers of delivery for quick resolution (within SLA); document learnings for self-reference.
    

  • Collaborate with other team members for timely resolution of errors
    

  • Assist new team members to understand the customer environment.
  
  Process Adherence:
  • Thorough understanding of organization and customer defined process; consult with mentor when in doubt. Adherence to defined processes.
    organization’ s policies and business conduct.
    
  
  

  Skill Examples:

  • Customer Focus: Focus on providing 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

  • Make rule-based decisions and judgments based on guidance from Lead

  • Analytical ability to understand the larger picture of customer issues.

  • Ability to follow SOP documents and escalate the alerts with in the SLA defined.

  • Willingness and ability to learn new skills domain knowledge etc.

  • Sr. Process Associate Quality Auditor SME

  • Frontline resource - Voice/Backoffice Quality Auditors SME
    
  
  

  Knowledge Examples:

• Familiar with Windows Operating Systems MS Word MS Excel.
  • English comprehension – Reading writing and speaking

  • Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)

  • Fair understanding of customer infrastructure ability to co-relate failures.

  • Familiarity with work allocation and intake functions

  • Experience level – 2 to 5 years
    
  
  
  Additional Comments:

  About UST HealthProof 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 startup 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. Customer Service Associate II Job Description: Reporting to the Customer Service Manager, the Customer Service Associate will provide exceptional customer service to the UST customers via inbound Call Center Operations. The service center will be open from 8am-6pm CST USA and will occur related schedules. Duties/Responsibilities: • Receive and respond to inbound phone calls for customer assistance • Respond to outbound phone call requests • Document all calls in ticketing and tracking systems • Respond to customer inquiries and provide data to customers within a required time frame • Act as liaison between claims department and providers • Research customer claims in the primary payor systems • Ensure highest level of customer service on every call • Perform other duties as assigned or necessary Required Skills/Abilities • High school degree required; Bachelor’s degree preferred • 2-3 years of relevant professional experience in Healthcare claims operations or 2-3 years of relevant experience in a Call Center environment • Previous Health Care Call Center/Customer Service Experience. • Must be able to work with minimal supervision. • Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts. • Excellent verbal and written communication skills. • Attention to detail and problem-solving skills • Proficiency with MS Office applications, especially Word and Excel. Overall Experience level: • Some experience in customer service setting preferred • Spanish speaking and written language proficiency preferred Location: Remote or Eastern Time Zone