HC and Insurance Operations Analyst

Summary

NTT DATA North America is a leading business and technology services provider, and they are seeking a HC and Insurance Operations Analyst to join their team. The role involves managing the entire claims process for insurance policyholders, providing updates and ensuring effective communication throughout the claims lifecycle.

Responsibilities

• 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
• Fraud Detection: Identify and flag potential fraudulent activities
• 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
• Collaboration: Work with management and team members to address service issues and concerns
• Empathy: Communicate with claimants with empathy and a willingness to help

Skills

• Must live in the Continental United States
• 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
• 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
• 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
• Employees must work from the same location consistently unless prior approval is obtained
• College degree preferred
• Successful completion of the certification program is desired

Qualifications

Must Haves

• Must live in the Continental United States
• 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
• 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
• 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
• Employees must work from the same location consistently unless prior approval is obtained

Nice to Haves

• College degree preferred
• Successful completion of the certification program is desired

Benefits

• 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
• Additional voluntary or legally required benefits