HC & Insurance Operations Processing Sr Rep at NTT DATA

Plano, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Jan, 26

Salary

18.0

Posted On

14 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Healthcare Claims Processing, HIPAA Compliance, Time Management, Problem Solving, MS Office, Data Analysis, Research Skills, Communication Skills, Adjudication, Quality Assurance, Professionalism, Attention to Detail, Database Management, PL/SQL, Amisys, Xcelys

Industry

IT Services and IT Consulting

Description

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Medical Claims Processor to join our team in Plano, TX for a remote position. This is a US based; W-2 project. All candidates will be paid through NTT DATA only. Role Responsibilities -Processing of Professional claim forms files by provider -Reviewing the policies and benefits -Comply with company regulations regarding HIPAA, confidentiality, and PHI -Abide with the timelines to complete compliance training of NTT Data/Client -Work independently to research, review, and act on the claims -Prioritize work and adjudicate claims as per turnaround time/SLAs -Ensure claims are adjudicated as per clients defined workflows, guidelines -Sustaining and meeting the client productivity/quality targets to avoid penalties -Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. -Timely response and resolution of claims received via emails as priority work -Correctly calculate claims payable amount using applicable methodology/ fee schedule -Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities -Time management with the ability to cope in a complex, changing environment -Ability to communicate (oral/written) effectively in a professional office setting Required Skills/Experience 1+ year(s) hands-on experience in Healthcare Claims Processing Previously performing - in P&Q work environment; work from queue; remotely 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools Key board skills and computer familiarity - Toggling back and forth between screens/can you navigate multiple systems. Working knowledge of MS office products - Outlook, MS Word and MS-Excel. --- Preferences Amisys &/or Xcelys Preferred "PL/SQL developer's job description typically includes: Database management: Administering, testing, and implementing computer databases Data analysis: Analyzing and manipulating data to create and modify reports Database performance: Identifying, investigating, and resolving database performance issues Security: Planning, coordinating, and implementing security measures to safeguard databases Database development: Creating databases, tables, and other data storage tools Database optimization: Optimizing data management and data retrieval tools Database best practices: Ensuring compliance with database best practices and standards Collaboration: Collaborating with other developers and project managers to enhance database functionalities Code reviews: Performing code reviews and unit testing of code on SQL and PL/SQL codes Bug fixing: Analyzing PL/SQL codes and performing bug-fixing Customer relationship: Managing customer relationships via regular meetings with clients and the business Minimum 8 years of experience" About NTT DATA: NTT DATA is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com. NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $18.00/hourly. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, 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.

Responsibilities

The role involves processing professional claim forms filed by providers and ensuring compliance with company regulations regarding HIPAA and confidentiality. The processor must prioritize work, adjudicate claims according to defined workflows, and maintain quality scores above specified thresholds.