NTT DATA is seeking a HC & Insurance Operations Processing Sr Rep to join our team. In this remote role, you will be responsible for processing professional healthcare claims, reviewing policies and benefits, and ensuring strict compliance with regulations and client-defined workflows.
What You'll Do
- Process professional claim forms files by provider
- Review policies and benefits
- Comply with company regulations regarding HIPAA, confidentiality, and PHI
- Abide by timelines to complete compliance training for NTT DATA and our client
- Work independently to research, review, and act on claims
- Prioritize work and adjudicate claims as per turnaround time and SLAs
- Ensure claims are adjudicated as per clients' defined workflows and guidelines
- Sustain and meet client productivity and quality targets to avoid penalties
- Maintain and sustain quality scores above 98.5% PA and 99.75% FA
- Provide timely response and resolution of claims received via emails as priority work
- Correctly calculate claims payable amount using applicable methodology and fee schedules
What We're Looking For
- 3+ years of hands-on experience in Healthcare Claims Processing
- 2+ years using a computer with Windows applications, navigating multiple screens and systems, and learning new software tools
- High school diploma or GED
- Prior experience performing within a production and quality work environment, working from a queue, and working remotely
- Strong keyboard skills and computer familiarity, including toggling between screens and navigating multiple systems
- Working knowledge of MS Office products: Outlook, Word, and Excel
Nice to Have
- Experience with Amisys
- Ability to communicate effectively (oral/written) in a professional office setting
- Effective troubleshooting leveraging research, analysis, and problem-solving abilities
- Strong time management with the ability to cope in a complex, changing environment
Technical Stack
- Windows applications
- MS Office: Outlook, Word, Excel
- Amisys
Work Mode
This is a fully remote position.
NTT DATA is an equal opportunity employer.
