Logo of Huzzle

Home

Matches

Explore

Manage

Health Clinical Services Associate

image

Accenture

Aug 23

Applications are closed

  • Job
    Full-time
    Junior & Mid Level
  • Customer Relations
    Healthcare
  • Bangalore

Requirements

  • Preferred 2 or 4-year university degree
  • Required a high school diploma or general equivalency diploma with 1-3 years of customer service and/or contact center experience
  • For Radiant internal candidates seeking promotion, must meet Accenture Careers Marketplace (ACM) requirements for promotion, and must have at least one year experience within Radiant Health Management
  • Excellent written and verbal communication skills in English, required
  • Ability to understand language nuances, intonation, accent and inference in spoken and written American English
  • Must pass American English and alternate language fluency test (“Test”) upon hire (non-US resident) by successfully completing internal written test and passing US Berlitz B2 level or Versant score 58 and above upon hire or upon assuming role
  • Proficient analysis and problem solving capabilities
  • Proficient critical thinking skills to resolve customer complex inquiries
  • Attention to details, ability to prioritize and multi-task
  • Basic computer knowledge with the ability to learn additional computer programs, required
  • Minimum 1 year customer service experience in a call center set up preferred

Responsibilities

  • Provides intake and prepare prior authorization requests for clinical review from Providers
  • Checks Member’s eligibility and plan benefits
  • Determines if requested service or case requires prior authorization review, intake processing, and/or clinical review
  • Creates cases for intake processing and prior authorization, and routes for clinical review as needed
  • Data entry of contacts into client systems and route as appropriate
  • Adheres to turnaround times in accordance with client requirements and regulatory and accreditation standards
  • Performs administrative tasks and work as directed by clinician, customer and/or Team Lead/Operations
  • Consults clinician and Team Lead/Operations Manager appropriately and in a timely manner
  • Responsibilities exclude collection of non-scripted information, evaluation or interpretation of clinical information, and providing medical advice/opinion on treatment or services
  • The work may be subject to applicable accreditation and regulatory standards and requirements and as such the associates will strictly follow department guidelines and tools to conduct their job requirements
  • Uses available resources to understand contractual and regulatory compliance requirements and reports suspected compliance issues on the day of discovery to a Team Lead, Manager, and/or the Compliance Department
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards
  • Responsible for reporting known or suspected data breaches on the day of discovery to a Team Lead
  • Manages incoming telephone calls from providers and members, using client scripts and client-approved screening guidelines
  • Accepts member notifications of inpatient admissions and accurately route for processing and concurrent review
  • Achieve target % of faxes received are routed
  • Fax Intake Individual and team daily production turnaround time target should be met or exceeded
  • Achieve target % expected accuracy in case creation, determining eligibility, determining prior authorization requirement and routing inbound fax to appropriate queue
  • Performs expected Quality rate
  • Participates in providing feedback to the Quality team for improvement suggestions
  • Works with auditing resources on individual and team error trends
  • Provides timely feedback to the Team Lead/Group Lead on quality issues, changes or trends
  • Attend and complete required training courses identified by HR and the project

FAQs

What is the job title for this position?

The job title is Health Clinical Services Associate.

What qualifications are required for this role?

Any graduation is required, along with a high school diploma or equivalent for those with 1-3 years of customer service and/or contact center experience.

What is the range of experience required for this position?

The position requires 1 to 3 years of relevant experience.

What skills are preferred for a candidate applying for this role?

Preferred skills include customer service experience, proficient analysis and problem-solving capabilities, critical thinking skills, attention to detail, and basic computer knowledge.

What will be the primary responsibilities of the Health Clinical Services Associate?

Primary responsibilities include providing support for prior authorization requests, checking member eligibility, data entry, managing telephone calls from providers and members, and adhering to turnaround times and quality standards.

Is prior healthcare experience necessary for this role?

While prior healthcare experience is preferred, the job is open to candidates with customer service experience. Specific healthcare management experience is not strictly required.

Will I need to take any language proficiency tests for this position?

Yes, non-US residents must pass an American English fluency test upon hire, including an internal written test and achieving a specified Berlitz B2 level or Versant score.

What type of team will I be working with?

You will be part of the Healthcare Claims team and support the clinical team in administering health claims and ensuring quality member outcomes.

Are there opportunities for training and development in this role?

Yes, you will be required to attend and complete necessary training courses as identified by HR and the project.

What are the service level metrics and KPIs for this role?

Associates are expected to achieve target percentages for fax routing, accuracy in case creation, eligibility determination, and timely processing of incoming calls.

Do I need to have experience working in a call center?

While not required, a minimum of 1 year of customer service experience in a call center setup is preferred.

Will I be required to travel for this job?

There are no specific travel requirements mentioned for this role; it primarily involves administrative tasks and support functions.

What is the work environment like for this position?

The work environment focuses on collaboration with clinical teams while ensuring compliance with regulatory standards and quality assurance protocols.

How can I apply for this job?

You can apply for the position by visiting the Accenture careers website or the specific job posting link provided by the company.

image

Accenture

Technology
Industry
10,001+
Employees
1989
Founded Year

Mission & Purpose

Accenture is a global professional services company with leading capabilities in digital, cloud, and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations Services, and Accenture Song—all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners, and communities.

Culture & Values

  • Client Value Creation

    Enabling clients to become high-performance businesses and creating long-term relationships by being responsive and relevant and by consistently delivering value.

  • One Global Network

    Leveraging the power of global insight, relationships, collaboration and learning to deliver exceptional service to clients wherever they do business

  • Respect for the Individual

    Valuing diversity and unique contributions, fostering a trusting, open and inclusive environment and treating each person in a manner that reflects Accenture’s values.

  • Best People

    Attracting, developing and retaining the best talent for our business, challenging our people, demonstrating a “can-do” attitude and fostering a collaborative and mutually supportive environment.

  • Integrity

    Being ethically unyielding and honest and inspiring trust by saying what we mean, matching our behaviors to our words and taking responsibility for our actions.

  • Stewardship

    Fulfilling our obligation of building a better, stronger and more durable company for future generations, protecting the Accenture brand, meeting our commitments to stakeholders, acting with an owner mentality, developing our people and helping improve communities and the global environment.

Benefits

  • Medical coverage

    Employees have a choice of national plans (PPO, EPO, HDHP) covering a wide range of medical services and prescription drugs.

  • Parental leave

    16 weeks paid maternity leave for birth parents. 8 weeks paid time off for other parents

  • Flexible work arrangements

    Flexible work arrangements help employees achieve work/life balance while also meeting Accenture’s business needs.

  • Paid time off

    PTO encompasses traditional vacation time along with paid sick leave; days vary based on level and tenure from 17 to 27 per year.

  • Holidays

    We provide 8 paid standard holidays and 2 culture days (for any days you choose), in addition to the PTO program.

  • Life Insurance

    Accenture provides you with a basic level of coverage and you can purchase more coverage for yourself and your family.

Get notified when Accenture posts a new role

Get Hired with Huzzle

Discover jobs with AI-powered precision. Autofill and track applications, create tailored resumes, and find the best opportunities across the web – all by simply chatting.

Already have an account?