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HC & Insurance Operations Processing Sr Rep at NTT DATA
Plano, Texas, United States -
Full Time

Start Date

Immediate

Expiry Date

09 Mar, 26

Salary

0.0

Posted On

09 Dec, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Insurance Claims Processing, Data Entry, Attention to Detail, Communication Skills, Problem Solving, Healthcare Insurance Knowledge, Prioritization, Quality Standards, Policy and Procedure Compliance, Medical Claim Document Review, Organizational Skills, Decision Making, Windows PC Applications, Time Management, Client Interaction

Industry

IT Services and IT Consulting

Description
In these roles you will be responsible for: Review and process insurance claims. Validate Member, Provider and other Claim's information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines University degree or equivalent that required formal studies of the English language and basic Math 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product. 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 6+ months of experience that required prioritizing your workload to meet deadlines Ability to communicate (oral/written) effectively to exchange information with our client. Commerce graduate with English as a compulsory subject
Responsibilities
The role involves reviewing and processing insurance claims, validating member and provider information, and determining payment criteria based on policies. Additionally, the position requires maintaining productivity goals and resolving complex situations according to established guidelines.