HC & Insurance Operations Senior Rep.

NTT DATA Services•Lincoln, NE

1d•Remote

About The Position

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 & Insurance Operations Senior Rep. to join our team in Lincoln, Nebraska (US-NE), United States (US). 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.

Requirements

6 Months of experience in claims adjudication, insurance operations, or related roles
6 Months of Work from home environment
High school diploma or GED
Must Live in 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.
Employees must have a dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment.
The workspace must be a permanent, unencumbered location used daily for work.
Employees must work with minimal distractions that do not interfere with business operations or service delivery.
Ideally, the workspace is isolated from other household members and used exclusively for job duties.
Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service.
Employees must work from the same location consistently unless prior approval is obtained.

Nice To Haves

Experience in healthcare, disability, life, auto, or property & casualty claims (preferred, role dependent)
Strong attention to detail and analytical skills
Solid understanding of insurance policies, benefits, and claims procedures
Ability to interpret complex regulations and contractual language
Effective written and verbal communication skills
Ability to manage high claim volumes in a fast-paced environment
Proficiency with claims processing systems and Microsoft Office tools
Strong problem-solving and decision-making abilities

Responsibilities

Review and adjudicate insurance claims to determine eligibility, coverage, and payment accuracy
Interpret policy language, benefits schedules, and governing regulations to ensure correct claim outcomes
Analyze claim documentation and supporting materials to verify completeness and accuracy
Identify discrepancies, missing information, or potential fraud and take appropriate action
Communicate claim decisions clearly to customers, providers, and internal stakeholders
Ensure claims are processed within defined service level agreements (SLAs)
Maintain accurate claim records and documentation in claims processing systems
Collaborate with quality, compliance, and audit teams to support continuous improvement
Adhere to privacy, confidentiality, and regulatory standards at all times