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 Medical Claims Processor to join our team in Plano, TX for a remote position.

This is a US based; W-2 project. All candidates will be paid through NTT DATA only.

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

-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

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

Required Skills/Experience  

Preferences

Amisys &/or Xcelys Preferred

Position's General Duties and Tasks

In these roles you will be responsible for:

•  Review and process insurance claims.
• Validate Member, Provider and other Claim’s information.
• Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
• Coordination of Claim Benefits based on the Policy & Procedure.
• Maintain productivity goals, quality standards and aging timeframes.
• Scrutinizing Medical Claim Documents and settlements.
• Organizing and completing tasks per assigned priorities.
• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
• Resolving complex situations following pre-established guidelines

Requirements for this role include:

• University degree or equivalent that required formal studies of the English language and basic Math
• 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions
• 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
• 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
• 6+ months of experience that required prioritizing your workload to meet deadlines

Preferences:  - Optional (nice-to-have’s)

• Ability to communicate (oral/written) effectively to exchange information with our client.
• Commerce graduate with English as a compulsory subject

Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST).  The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.

Roles and Responsibilities:

• Process Adjudication claims and resolve for payment and Denials

• Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
• Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations

• Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
• Organizing and completing tasks according to assigned priorities.
• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

• Resolving complex situations following pre-established guidelines

Requirements:

• 1-3 years of experience in processing claims adjudication and adjustment process
• Experience of Facets is an added advantage.
• Experience in professional (HCFA), institutional (UB) claims (optional)
• Both under graduates and post graduates can apply
• Good communication (Demonstrate strong reading comprehension and writing skills)
• Able to work independently, strong analytic skills

**Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.

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 starting hourly range for this remote role is $18.00/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.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.