Associate Claims - Claims Adjudication - US Healthcare - GGM/BLR

Job Title

Associate - Claims

Requirement Type

Full-Time Employee

Job Location

Bangalore/Gurugram

Requirement Level

Associate - Claims

Hiring Manager

Team Lead, Business Operations

Primary Skill

Business Operations

Claims

Business

Business Operations

Skill Category

Generic

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler.  It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 45 million lives across 14 states.

A regular in Fortune 500 list, Elevance Health ranked 20 in 2022. Gail Boudreaux, President and CEO of Elevance Health has been a consistent name in the Fortune list of most powerful women and currently holds 4th rank on this list.

ABOUT CARELON

Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.

Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective, and efficient.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.

Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB POSITION

Carelon Global Solutions India is seeking a highly creative and meticulous Associate - Claims, who will be responsible for all Processing level delivery & performance as per set SLA parameters.  The incumbent will report to Team Lead Business operations and must understand the business delivery, present and metrics with leadership; brief and deliver all in-house process delivery & requirements, apart from coordinating with onshore partners as and when required.

JOB RESPONSIBILITY

Associate Claims(Business Operations) will be responsible for the following:

• Bachelor's degree (Non BTech) with minimum 1+ years of experience-Experienced/Fresher
• Familiar with MS Office basics (Excel/Power point/Outlook primarily)
• Very strong Communication & Comprehension skills with the ability to evaluate key technical/Calculations needed to deliver basic process delivery
• Working knowledge on basic technologies around persistence, search, graph and distributed technologies
• Excellent oral and written communication skills
• Healthcare domain knowledge - nice to have
• Flexible to work in any shift & in office premises per set organizational/Business requirements

QUALIFICATION

• Bachelors or Masters’ degree in fine arts/ design
• Non-BTech (preferably)

EXPERIENCE

• 1+ years of overall experience in US healthcare in Claims adjudication including extra-ordinary internal personal skills, communication skills 

SKILLS AND COMPETENCIES

• Responsible for Internal/Onshore calibration; Maintain updates tracker; Upskilling requirements & plan upskilling sessions – as needed
• Manage new hire associates and plan for their training and nesting as needed
• Excellent Data management – Inventory allocated; status of pended / on hold inventory
• Should be able to manage and track onshore connects, suggest/drive automation ideas & demos and help them develop  as needed
• Conduct team huddle on process updates, internal sample audit, participate in error review/root cause at operations level and provide performance data for group  aligned with
• Agile & Solution centric
• Inclusive
• Flexible to work in any shifts/Work from office

THE CARELON PROMISE

Aligning with our brand belief of ‘limitless minds are our biggest asset’, we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

• Extensive focus on learning and development
• An inspiring culture built on innovation, creativity, and freedom
• Holistic well-being
• Comprehensive range of rewards and recognitions
• Competitive health and medical insurance coverage
• Best-in-class amenities and workspaces
• Policies designed with associates at the center

EQUAL OPPORTUNITY EMPLOYER

Carelon is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*