HC & Insurance Operations Processing Sr Rep

Overview

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 has 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.

• Processing of professional claim forms/files by provider
• Reviewing policies and benefits
• Comply with company regulations regarding HIPAA, confidentiality, and PHI
• Abide by 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 client-defined workflows and guidelines
• Meet client productivity/quality targets to avoid penalties
• Maintain 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 leveraging research, analysis and problem-solving abilities
• Time management in a complex, changing environment
• Communicate effectively (oral/written) in a professional office setting

• 1+ year hands-on experience in Healthcare Claims Processing
• Previously performing in a PQ work environment; work from queue; remotely
• 2+ years using a computer with Windows applications, navigating multiple screens and systems
• Keyboard skills and computer familiarity
• Ability to toggle between screens and navigate multiple systems
• Working knowledge of MS Office products – Outlook, Word, and Excel

• Amisys and/or Xcelys preferred
• Understand, gather, and prepare requirements for business
• Ability to work under supervision with internal and external teams to understand customer requirements
• Ability to elaborate on project details
• Collaborate with Automation Engineers, Machine Learning Engineers, Data Analysts and BI Analysts to execute deliverables
• Technical writing, decision making, and problem-solving skills
• Strong command of English
• Flexible with working hours; may require UK or US shifts depending on business requirements

• Appropriate mathematical knowledge
• Strong communication and critical thinking skills
• Committed to professional development
• Customer-focused
• Working knowledge of programming languages or tools (Python, D3, Java script, HTML5, SQL, Power BI, Tableau, Azure Cognitive Services, Power Platforms)

Graduates or nearing course completion

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

NTT DATA is an equal opportunity employer and considers all applicants without regard 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…