HC and Insurance Operations Analyst

NTT DATA Services•Oklahoma City, OK

15d•Remote

About The Position

We are currently seeking a HC and Insurance Operations Analyst to join our team. 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. We are seeking a dedicated Claims Case Manager to provide comprehensive claim servicing to our insurance policyholders. This role involves managing the entire claims process from intake to final decision, ensuring frequent status updates to claimants through their preferred communication channels (email, phone, mail, etc.). The ideal candidate will have a strong analytical skill set, a thorough understanding of the claims process, and the ability to communicate with empathy and detail.

Requirements

2 years in an analytical role reviewing medical benefits and claims.
2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease).
4 years of experience reviewing and assessing medical records.
Experience articulating claim requirements clearly and concisely.
Minimum high school diploma or GED; college degree preferred.
At least 1 year of experience working from home with proven productivity and quality.
Designated quiet area for completing calls.
Must live in the Continental United States
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.
Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.
A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location.

Nice To Haves

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

Responsibilities

End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision.
Status Updates: Provide frequent updates to claimants through their preferred communication channels.
Document Review: Thoroughly review medical documents, claim forms, and policy notes.
Communication: Interact with claimants with empathy and attention to detail.
Team Collaboration: Work with team members to ensure high-quality service and resolution of issues.
Record Keeping: Maintain accurate records and reports throughout the claims process.
Data Analysis: Compile and analyze data to identify trends and perform root cause analysis.
Claim Initiation: Gather information and initiate claims through various channels.
Detailed Logging: Log and update pertinent information throughout the claim lifecycle.
Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone.
Proactive Follow-Up: Follow up on pending claims and assist in gathering required medical records.
Benefit Calculation: Calculate benefit amounts and process payments through the claims system.
Multitasking: Manage a caseload of active claims and perform end-to-end steps.
Attention to Detail: Ensure accuracy and organization in logging, tracking, and reviewing claims. Identify and flag potential fraudulent activities.
Collaboration: Work with management and team members to address service issues and concerns.
Empathy: Communicate with claimants with empathy and a willingness to help.