HC & Insurance Operations Processing Sr Rep
About The Position
NTT DATA is seeking a Healthcare and Insurance Operations Processing Senior Representative to process professional healthcare claims. The role involves reviewing policies and benefits, researching and adjudicating claims in accordance with client workflows and guidelines, and calculating payable amounts using applicable methodologies and fee schedules. The representative must prioritize work to meet turnaround times and service-level agreements, respond to claims received by email as priority work, and meet client productivity and quality targets. The role also requires compliance with HIPAA, confidentiality, PHI, and required company and client training timelines. The posting identifies the location as Plano, Texas, while also describing the opportunity as remote.
Requirements
- Three years of hands-on experience in healthcare claims processing.
- At least two years of experience using a computer with Windows applications, navigating multiple screens and computer systems, and learning new software tools.
- High school diploma or GED.
- Prior experience in a productivity and quality (P&Q) work environment, working from a queue, and working remotely.
- Keyboard skills and computer familiarity, including toggling between screens and navigating multiple systems.
- Working knowledge of Microsoft Office products, including Outlook, Word, and Excel.
Nice To Haves
- Experience with Amisys.
- Ability to communicate effectively, orally and in writing, in a professional office setting.
- Troubleshooting ability supported by research, analysis, and problem-solving skills.
- Time management skills and ability to cope in a complex, changing environment.
Responsibilities
- Process professional claim form files submitted by providers.
- Review policies and benefits.
- Comply with company regulations regarding HIPAA, confidentiality, and PHI.
- Complete NTT DATA and client compliance training within required timelines.
- Independently research, review, and act on claims.
- Prioritize work and adjudicate claims within turnaround times and SLAs.
- Adjudicate claims according to client-defined workflows and guidelines.
- Meet client productivity and quality targets.
- Maintain quality scores above 98.5% PA and 99.75% FA.
- Respond to and resolve claims received by email in a timely manner, treating them as priority work.
- Calculate payable claim amounts using the applicable methodology and fee schedule.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
