HC & Insurance Operations Processing Sr Rep

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

 

For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

 

NTT DATA currently seeks a Claims Processing Associate to join our team for a remote position.

Role Responsibilities

-Processing of Professional claim forms files by provider

-Reviewing the policies and benefits

-Comply with company regulations regarding HIPAA, confidentiality, and PHI

-Abide with the timelines to complete compliance training of NTT Data/Client

-Work independently to research, review and act on the claims

-Prioritize work and adjudicate claims as per turnaround time/SLAs

-Ensure claims are adjudicated as per clients defined workflows, guidelines

-Sustaining and meeting the client productivity/quality targets to avoid penalties

-Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.

-Timely response and resolution of claims received via emails as priority work

-Correctly calculate claims payable amount using applicable methodology/ fee schedule

Required Skills/Experience  

• 1+ years hands-on experience in Healthcare Claims Processing
• 2+ years using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
• High school diploma or GED.
• Previously performing – in P&Q work environment; work from queue
• Previous remote work experience
• Key board skills and computer familiarity –
• Toggling back and forth between screens/can you navigate multiple systems.
• Working knowledge of MS office products – Outlook, MS Word and MS-Excel.
• Must be able to work 7am - 4 pm CST online/remote (training is required on-camera).

Preferences

-Amisys

-Ability to communicate (oral/written) effectively in a professional office setting

-Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities

-Time management with the ability to cope in a complex, changing environment

Grade 3 Job Description

• Understand, Gathering and Prepare the requirements for Business.  
• Works under supervision with internal and external teams to understand customer requirements
• Ability to elaborate on the details of a project  
• Collaborate with Automation Engineers, Machine Learning Engineers, Data Analysts and Business Intelligence Analyst to execute deliverables.
• Must possess technical writing, decision making, and problem-solving skills.
• Must possess strong command over English language.
• Must be flexible with working hours – may require to work in UK or US Shifts depending on the business requirement.

 

Skills

• Appropriate mathematical knowledge
• Strong communication and critical thinking skills
• Strives for professional development
• Customer focused
• Working Knowledge of (any) job associated programming languages (Python, D3, Javascript, HTML5, SQL, PowerBi, Tableau, Azure Cognitive Services, Power Platforms)

 

Education and Experience

Graduates or nearing course completion