HC and Insurance Operations Analyst

NTT DATA • Lincoln, NE

385d • $45,760 - $45,760 • Remote

About The Position

The HC and Insurance Operations Analyst role at NTT DATA involves providing comprehensive claim servicing to insurance policyholders, managing the entire claims process from intake to final decision. This position requires strong analytical skills to review medical documents and claims forms, as well as effective communication to keep claimants informed throughout the process. The ideal candidate will demonstrate a high work ethic and a passion for delivering exceptional customer service, acting as the single point of contact for claim resolution.

Requirements

• 2 years in an analytical role reviewing medical benefits and claims.
• 2 years of claims adjudication experience, preferably in medical supplemental products.
• 4 years of experience reviewing and assessing medical records.
• Experience articulating requirements to finalize claims clearly and concisely.
• Minimum high school diploma or GED.

Nice To Haves

• College degree preferred.
• Minimum of 1 year experience in a work-from-home setup delivering desired productivity and quality.

Responsibilities

• Initiate claims through various input channels, gathering information over the phone.
• Log and update pertinent information throughout the lifecycle of the claim.
• Thoroughly review claims documents to determine applicable benefits and finalize claims.
• Communicate via email, mail, and phone to articulate required medical records and claim information.
• Follow up on pending claims proactively and assist in gathering required medical records.
• Review incoming medical records and tag them to the inventory of pending claims.
• Perform detailed reviews to identify applicable benefits and review related certificate language.
• Review trends and apply business analytics to determine ongoing payments and flag fraudulent activities.
• Calculate benefit amounts payable and process payments through the claims system.
• Refer claims for additional review based on dollar threshold matrix and correct errors as needed.
• Manage a caseload of claims and perform end-to-end steps from intake to finalization.
• Collaborate with management and team members to address service issues and concerns.
• Demonstrate ownership of end-to-end resolution with attention to detail and accuracy.

Benefits

• Medical, dental, and vision insurance with employer contribution.
• Flexible spending or health savings account.
• Life and AD&D insurance.
• Short- and long-term disability coverage.
• Paid time off.
• Employee assistance program.
• Participation in a 401k program with company match.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees