Conduent Associate IV, Service Delivery Healthcare in Cebu City, Philippines

Associate IV, Service Delivery Healthcare

Description

Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com .

Purpose:

  • Responsible for providing professional and analytical support to medical services programs, including implementation, operation and contract compliance (e.g., Medicare); Utilization Review; Condition Management; Health Care Coordination; Case Management; Insurance Claim Administration; Pharmacy Services; Medical Services; Collection Services; Negotiates liability settlement of medical claims with third parties or healthcare providers; seeks reimbursement from healthcare providers and/or ensures payment of claims by appropriate insurance carrier.

  • Provides administrative support to the claim processing function.

  • Insurance Billing Specialist - Provides administrative support to the hospital billing department

Scope:

General:

  • Senior level job with extensive work experience

  • Has developed expertise in a variety of work processes through job-related training

  • Generates new and innovative solutions to complex problems, and proposes improvements to processes

  • Analyzes complex technical problems and delivers solutions where precedent may not exist

  • Works autonomously within established procedures and practices

  • May provide immediate direction to a unit or group of employees, assigning tasks, checking work at frequent intervals and maintaining schedules

  • A portion of time is normally spent performing individual tasks relation to the unit or sub-unit

  • Will have specialized external certification (technical roles)

Primary Responsibilities:

  • May perform one or more of the following:

  • Researches unpaid and denied complex claims to determine course of action.

  • Checks the accuracy and completion of routine and complex claim forms.

  • Prepares and/or develops required reports.

  • Corresponds with agents, policyholders, hospitals, doctors and claimants to secure needed documentation and validates whenever necessary.

  • Submits letters of appeal on denied insurance claims.

  • Can function as a Lead or Subject Matter Expert

  • Team leader -Defines team roles and activities to meet team objectives, balancing skills, experience, team styles and workload.

  • All other duties as assigned.

  • Insurance Billing Specialist:

  • Performs analyses and manages the day-to-day operations of the billing process.

  • Reviews and analyses each billing cycle to ensure accuracy.

  • Researches billing issues. Responds to telephone inquiries and complaints.

  • Obtains supporting documentation when needed.

  • All other duties as assigned

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf .

Job Service Delivery Healthcare

Primary Location Philippines-Central Visayas-Cebu City

Organization Financial Service Healthcare

Unposting Date Ongoing

Req ID: 18031104