HC and Insurance Operations Analyst

Req ID:306592

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a HC and Insurance Operations Analyst to join our team.

Claims Case Management,

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, 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.

Pay for this role is $22.00hr

Description of the role:

Provides end to end claim servicing to Insurance policyholders. End to End includes include every aspect of the claim right from Intake to final Decision. The role includes frequent status updates of the claim to the claimant through their preferred communication channel which includes email, phone, mail etc.

Case Management role requires the individual to review medical documents, claim forms and policy notes extensively utilizing their high analytical skill set. Thorough understanding of the entire life cycle of claims process and the related system is key to being a successful case manager. Communicating with great empathy and the level of details in each opportunity to interact with the claimant is extremely critical for the desired level of outcome.

Team members with high work ethic and passion for delivering customer experience being single point of contact for end-to-end resolution is desired.

Basic Qualifications:

• 2 years in an analytical role in reviewing medical benefits and claims.
• 2 years Claims Adjudication Experience preferably in Life, Annuity and Supplemental products including Critical Illnesses such as cancer, stroke, heart attack, kidney disease, etc is desired.
• 4 years experience of reviewing and assessing medical records.
• Experience in a job where the candidate had to understand and verbally articulate the requirements to finalize a claim in a concise and clear manner is vital for this role.
• Minimum High school diploma or GED.

Responsibilities:

• Initiating of claim through various input channels including gathering of information over the phone.
• College Degree Preferred
• Out of the total experience, preferably minimum of 1 year experience in work from home set up delivering desired level of Productivity & Quality.
• Detailed inputs to log and update pertinent information throughout the lifecycle of the claim.
• Thorough review of claims documents to determine applicable benefits and all relevant information required to finalize the claim.
• Omni Channel Correspondence (E-Mail/Mail/Call) to articulate the required medical records and claim information to make a final decision on the claim.
• Frequent follow through on pending claims in a proactive manner and offer assistance to gather required medical records
• Review the incoming medical records and appropriately tag them to the inventory of pending claims and perform a thorough review to calibrate on true outstanding requirements
• Perform a detailed review to identify applicable benefits, review of related certificate language and all medical records as part of claims adjudication.
• Review trends and apply business analytics to determine ongoing payments for existing claims but also flag for any fraudulent activities.
• Calculate the benefit amount payable across all applicable benefits and apply the business rules to process the payment through the Claims system.
• Refer the dollar threshold matrix to determine the claims that needs to be sent for additional review and instantly make corrections if there are errors reported.
• Ability to multitask for managing a caseload of claims active inventory and perform end to end steps right from Intake to Finalizing a claim.
• Attention to detail and organization to log, track, review and claims in the required turnaround time.
• Collaborating with management or other team members as appropriate to proactively address service issues and concerns.
• Demonstrated ability to fully own end to end resolution and handle all the tasks related to that claim with great detail and accuracy.
• Designated quiet area to complete calls while working from home.
• Verbally correspond with extreme empathy and willingness to help.

Any state specific certification related to perform the job duties shall be sponsored by the company and successful completion of the certification program is desired.

Required schedule availability for this position is between Monday-Friday 7:00 am to 7:00 pm (Central Time), OT during evenings and Saturdays could also be required based on business need, particularly during the months of Nov - Feb.

New hire must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process

Must Pass Drug screen

Must Pass a background check with Education check and employment verification check.

#INDBPO

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. 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 one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us atus.nttdata.com

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