CTS Recruitment 2023 Apply Online Senior Process Executive Job vacancy

CTS Recruitment 2023 Eligibility Details

Senior Process Executive

Qualification: 

• Graduate (exclusion:
• BE/BTech/MCA)
• For Medical Management Bachelor’s degree in Nursing or any health science related field.
• For NA High School Equiv.

Data Processes:

• Efficiently Process predefined number of transactions as assigned with highest level of accuracy as agreed upon by the client.
• Provide highest level of customer satisfaction.
• Strive to understand and resolve issues/queries at the first instant.
• Maintain the business controls as per the requirement.
• Articulate/ communicate in a manner which is understood by clients / endusers.
• Connect & provide highest level of satisfaction to the customer.

For Member Management:

• Generate clientspecified reports relating to operations.
• Respond to data requests and other inquiries from the client.
• Release WCUM determinations to claim stakeholders following clientestablished protocols.
• Identify the medical flags in the client system.
• Provide reports and other data requests specified by the client.
• Serve as first level contact for customer complaint resolution.
• Provide reports and other data requests specified by the client.

For Medical Management:

• Identify cases eligible for medical reviews and assign these to appropriate reviewers.
• Reach out to the client for any problems identified in the cases for review.
• Adhere to Utilization Review Accreditation Commission (URAC), jurisdictional, and/or established MediCall best practice UM time frames, as appropriate.
• Adhere to federal, state, URAC, client, and established MediCall best practice WCUM time frames, as appropriate.
• Develop a complete understanding of the Medical management Procedures.
• Perform medical review assessment (MRA) on utilization of health services (eg healthcare plans, workers compensation products etc) in an accurate, efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federal mandates.
• Provide succinct negotiable points based on the submitted medical records that identify necessary medical treatment, casually related care, response or lack of response to treatment, etc.
• Identify missing records and information that are necessary in the completion of the medical review assessment.

Employee Status : Full Time Employee

Shift : Day Job

Selection Process for CTS Recruitment 2023

Selection Will be Based either Written Exam/Interview

How to Apply CTS Recruitment 2023 at cognizant.com?

Interested and Eligible Candidates can apply the post on or before last date