Why join EXL?
At EXL, were more than just an analytics, operations management, and technology Company. We focus not only on our outstanding Team Members, but on our growing industry as well.
Headquartered in NYC, EXL has more than 27,000 professionals situated in locations throughout the United States, Europe, Asia, Latin America, and South Africa.
Our EXL Team Members receive the benefit of:
Valuable Compensation Package:
Comprehensive Health & Welfare Benefits:
Inviting Culture & Team-Oriented Philosophy:
This position is responsible and accountable for maintaining subject matter expert (SME) level knowledge on designated accounts which includes in-depth knowledge of Health Integrated policies and procedures. Functionally, this position provides daily queue support, answers questions from staff members, monitors and responds to escalation queues in a timely manner. Additionally, this person will provides business process input and experience to the call center leadership to improve quality outcomes or as requested. This person will support intake supervisors with day to day tasks
50% Provide queue support as directed while adhering to the Utilization Management service delivery standards
20% Follow up on escalated issues or requests:
• Research, correct, and record case errors generated by intake personnel.
• Escalate matters to supervisors as needed.
20% Subject Matter Expert:
• Advance knowledge of all client products.
• The ability to identify gaps in business processes and present recommendation to leadership.
• Support team member by assisting with inquires and processes.
5 % Precepts new hires to the designated accounts. This includes:
• organization of training delivery
• creation of training agenda
• creation of training objectives
• effective planning that has benchmarks for assessment of trainee’s abilities that will be a major contribution to the new hire’s future with HI or the retention of an existing employee
• ability to deliver training that results in a self-sufficient employee able to accurately execute his/her job task
5% Accountable for fostering the team environment through active participation in team activities; maintaining a positive working environment; helping with special projects and to be a part of the solution.
• Supports and fosters a positive working environment
• Identifies and resolves potential personnel/peer problems and issues proactively, readily utilizing available resources, Supervisors and Call Center Managers as a resource.
• Communicates to Call Center Supervisors and Managers on all work related and non-clinical problems issues and /or concerns as they arise.
• Communicates to the Supervisors and Manager of Utilization Management any issues or concerns related to the quality of care following appropriate Health Integrated policies/procedures;
• Maintains a courteous and processional attitude when working with all Utilization Management staff members and the management team;
• Actively participates in team meetings and all team building events
• Timely identifies and communicates to applicable practitioners, providers and the health purchaser staff all issues and concerns related to the case at hand
• Communicates to the Supervisors and Call Center Manager any issues or concerns related to quality of care, following appropriate Health integrated polices and procedures
• Works, communicates and collaborates in harmony and in a courteous and professional manner with the patient, practitioner, provider and multidisciplinary health care team member all issues, concerns and/or as the UM Plan is revised and/or new services are implemented/terminated
• Serves as a liaison and patient advocate when deemed applicable for quality of care and cost outcomes
• Communicates appropriately and according to policy and/or regulatory requirement with the practitioner(s), provider(s), and patient(s) legally appointed representative and UM coverage
Utilization Management healthcare professional experience with medical records, claims and coding, as well as, having experience & certified or mastered the following:
• Demonstrated proficiencies with Microsoft Office suite of products including Word; Excel; Power Point and Visio – must have created mid-level complex excel spreadsheet; showcase several written documents in word that have accompanying Visio flow charts and must have a power point slide show completed.
• Ability to self-motivate, prioritize and self-direct daily activities based on business needs as well as to redirect resources as appropriate based on dynamic priorities.
• Designated SME in a minimum of two lines of business of a client account.
• Demonstrated ability to effectively train according to the Client Account guidelines and/or coach new or existing employees.
• Ability to monitor the queues and know when to take action to maintain key metrics.
High School Diploma required. Two years of advanced education/college or graduation preferred or equivalent work experience.
Work Experience Requirements:
Utilization Management healthcare professional experience with medical records, claims and coding position; queue monitoring experience; demonstrated ability to write procedures that flow logically and result in ease of staff training with minimum errors; successfully trained 3 or more new hires or existing staff on a new still.