Account Description – Healthcare Account (Wipro BPO)

The Healthcare Account at Wipro BPO focuses on providing customer support and back-office services for U.S.-based healthcare and insurance clients. Agents handle inquiries from patients, healthcare providers, and insurance members regarding claims, benefits, eligibility, billing, and policy information.

The role ensures compliance with healthcare regulations (like HIPAA), maintains accuracy and confidentiality, and supports members in navigating the healthcare system efficiently.

Key Responsibilities

1. Customer Support:

• Handle inbound and outbound calls or emails from healthcare members, patients, and providers.
• Provide information on eligibility, coverage, claims status, billing, and account details.

1. Claims and Data Processing:

• Review, verify, and process claims, authorizations, or enrollment requests accurately.
• Ensure correct documentation in the system following client and company standards.

1. Problem Resolution:

• Investigate and resolve issues related to benefits, billing discrepancies, or denied claims.
• Escalate complex issues to higher support teams when necessary.

1. Compliance and Confidentiality:

• Maintain strict adherence to healthcare privacy laws such as HIPAA.
• Handle sensitive patient and insurance data responsibly.

1. System and Record Management:

• Update customer records in CRM systems after each interaction.
• Follow up on pending cases and ensure timely resolution.

1. Quality and Performance:

• Meet targets for accuracy, call quality, AHT (Average Handle Time), and CSAT (Customer Satisfaction).
• Participate in training sessions to stay updated on healthcare processes and policies.

1. Team Collaboration:

• Work closely with other teams such as claims, provider relations, and quality assurance.
• Share feedback and insights to improve process efficiency and customer satisfaction.

Job Requirements

Senior High School Graduate

With Or without bpo experience

Virtual Process ( With laptop or desktop ) required