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BPO HC and Insurance Operations Analyst

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Date: Nov 27, 2021

Location: Plano, TX, US

Company: NTT DATA Services

General Description:


The Claims Support Analyst will work as part of a centralized analyst team to support efficient operations for the claims processing team(s). The Analyst will review customer requests, escalations, system changes and defects, CMS changes, and play a vital role in determining the appropriate course of actions and communicating those steps to various stakeholders.
The Analyst will be expected to contribute to publication of a weekly “Executive Summary” report for the items described in the Roles and Responsibilities.
The duties described are intended to provide generalized expectations; The role of the Analyst is ultimately to support the end-to-end claims operations. Not all duties can be documented as the business needs are fluid.
Roles and Responsibilities:


Additional Scope and New Process Review: The Claims Support Analysts shall partner with internal and external stakeholders to drive successful transition of work items for new or additional work for NTT. This will do this by:
-Being a key participant in the review of additional or new work items.
-Creating and/or modifying business requirements and appropriate documentation
-Representing NTT Data to key stakeholders in the discussions or work transitions and implementations
-Creating and sharing post-mortem review of work transitions and implementations
Check Run: The Claims Support Analysts will ensure the successful execution of check run. They will do this by:
-Reviewing all necessary pre-check run reporting
-Scheduling and executing check run no later than 4:15PM CST on Tuesdays or otherwise specified date
-Communicating with NTT leadership and designated BCBSM contacts with all communications relating to check run, including but not limited to: issues, clarifications, and the successful execution.
Documentation: The Claims Support Analysts will assist in creating and providing accurate documentation for all facets of claims operations. They will do this by:
-Reviewing all system logic changes, CMS changes, etc. and assisting with the incorporation into documentation
-Assisting in the maintenance, review, and/or posting of Desk Level Procedures, calculations, or other necessary documentation
Escalations: The Claims Support Analysts will review, resolve, and communicate closure on all escalated items received from the customer or identified internally. This includes:
-Serving as the project leader for escalated issues, identified either by the customer or internally.
-Performing necessary research, analysis, summarization, and assisting in remediation procedures if necessary
-Monitoring and resolving incoming requests from the Management Escalations mailbox. Requests received prior to 2PM CST will be resolved same-day; requests received after 2PM CST must be resolved by 12PM CST the following business day.
Executive Summary Publication: The Claims Analyst will collaborate, gather information, and publish a weekly Executive Summary Report for senior and executive-level leadership. This expectation includes:
-Consolidating multiple reports and data sources into a singular template
-Delivering the Executive Summary to the designated recipients by the close of business on Mondays.
Process Improvements: The Claims Support Analysts will continuously identify and implement process improvements and best practices. They will accomplish this by:
-Perpetually reviewing claims procedures, operations, etc. and providing suggestions for operational improvement and best practices
-Review team suggestions received through Knowledge Base, the Team Suggestions Outlook distribution list, and all other sources
System Defects: The Claims Support Analysts shall be responsible for the end-to-end identification, triage, and communication for ikaSystem defects. They will do this by:
-Maintaining an expert-level understanding of system logic and functionality
-Carefully reviewing all ikaSystem enhancements, logic, and functionality changes for impacts to the claims operations
-Reviewing reported system defects, comparing system functionality to system logic programming, and rendering a determination on whether the reported defect should be submitted to the customer for additional review.
-Monitoring and efficiently tracking all communications, internal and external, relating to system defects. The tracking will be stored on a secured NTT document repository at all times and updated at least once per week, by the close of business on Fridays.
-Developing a monthly slide for the SLA Meeting showcasing significant defects and their impacts to NTT
-Partnering with the customer, NTT IT, and the training teams to determine appropriate “workarounds” for legitimate defects; including the communication of these workarounds to the team, as well as assisting with documentation if needed.
Reporting: The Claims Support Analysts will be responsible for the accurate and timely creation, review, and delivery of a variety of reports for both internal and external audiences. 
Transmittals: The Claims Support Analysts will oversee the creation, tracking, and timely return of transmittal files to BCBSM. This will be accomplished by:
-Reviewing incoming transmittal files for accuracy, thoroughness, clarity, and understanding within 1 business day of receipt
-Creating a transmittal tracking number using MAR2 within 1 business day of transmittal file receipt
-Determining the feasibility of automated solutions to complete the transmittal (E.g., scripting, AFTE BOT development, etc.)
-Providing an accurate and up-to-date transmittal tracker to NTT Leadership by close of business each Friday
-Returning completed transmittal files to the appropriate owners within 1 business day of successful post-audit review


Nearest Major Market: Plano
Nearest Secondary Market: Dallas