Associate - Transaction processing - Sutherland Global Solutions
(2025-08)
- Process and adjudicate US healthcare claims by verifying eligibility, benefits, and policy guidelines.
- Review medical documents and claims data to ensure accuracy before transaction processing.
- Handle FSA (Flexible Spending Account) and HRA (Health Reimbursement Arrangement) claim processing in accordance with healthcare regulations.
- Perform detailed analysis of claim submissions and apply business rules to determine claim approval or rejection.
- Ensure all transactions meet productivity, quality, and turnaround time (TAT) standards.
- Maintain compliance with HIPAA and US healthcare regulatory requirements while handling patient data.
- Identify discrepancies in claim data and escalate issues to the appropriate teams for resolution.
- Support internal quality checks and ensure high accuracy in transaction processing.
- Collaborate with team members and supervisors to improve workflow efficiency and process improvements.
- Update claim status and maintain proper documentation within internal processing systems.
Customer Service Associate - Firstsource solution Pvt Ltd
(2024-03 - 2025-04)
- Preparing daily allocations file to segregate the task amongst the team member.
- Prioritising the sensitive clients queries and aged queries.
- Reviewing and analysing client's documents to meet their obligations.
- Verifying the client eligibility and account details in order to process the payment.
- Take ownership of each customer while empathizing and prioritizing customer needs.
- Resolve conflicts and manage customer expeditions.
- Determine customer needs and provide appropriate solutions though relationship building.
- Escalating any sort of issues to the management to do the better client service
