Job Description

Role & Responsibilities

• Design, analyze, and implement benefit coding change requests with a high level of precision, ensuring alignment with client specifications and regulatory requirements.

• Gather, interpret, and evaluate complex client requirements to assess the impact of benefit designs on claims processing; effectively communicate tailored benefit setup options to stakeholders and internal teams, thereby advising on optimal solutions.

• Manage non-standardized plan design concepts and client programs by overseeing coding, rigorous testing, and validation processes to ensure accuracy and compliance.

• Lead collaborative dialogues within cross-functional teams to clarify client intent and optimize program setups, fostering alignment across project deliverables.

• Serve as a key troubleshooter by coordinating resolution efforts among multiple internal and external teams; ensure timely implementation of solutions and maintain high client satisfaction.

• Partner with technical and operations teams to translate client-specific requirements into detailed technical design specifications and data flow models, supporting development and coding efforts.

Experience & Qualifications

• Demonstrated knowledge of claims processing methodology with compulsory experience in working within Facets platforms.

• Expertise in benefit configuration and group setup processes, enabling precise and compliant benefits administration.

• Previous exposure to Healthcare Business Process Outsourcing (BPO) environments, delivering operational efficiencies and client-focused solutions.

• A minimum of 3 years' professional experience in claims processing within Facets environments, showcasing strong problem-solving and technical skills.

• Educational background meeting at least a high school diploma or equivalent undergraduate coursework relevant to healthcare or information systems.

͏

Performance Delivery Metrics

No
Performance Parameter
Measurement Criteria

1
Process Adherence
Number of cases resolved daily; compliance with process and quality standards; achievement of Service Level Agreements (SLAs); client Pulse survey scores; and overall customer feedback.

2
Self-Management & Development
Productivity and efficiency metrics; attendance and punctuality records; completion of required training hours and technical certifications.

Candidates will be evaluated based on these performance indicators to ensure high-quality service delivery, continuous professional growth, and alignment with Wipro LLC's commitment to client satisfaction and operational excellence.