HC and Insurance Operations Processing Senior Representative
Title: HC & Insurance Operations Processing Sr Rep Location: Plano United States Job Description: At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. 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. NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for:
- 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
Requirements:
- 1-3 year(s) hands-on experience in Healthcare Claims Processing
- 2+ year(s) 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; remotely
- 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).
Preferred Skills & Experiences:
- Amisys Preferred
- 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
About NTT DATA NTT DATA is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com . NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The pay rate for this remote role is $18 Hourly . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. Apply Job! Apply to this Job