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The BPO Health Care and Insurance Operations Associate role at NTT DATA involves reviewing and processing insurance claims, validating information, and maintaining productivity goals. Candidates should have a university degree and 1-2 years of relevant experience in data entry and decision-making. The position requires strong attention to detail and familiarity with healthcare insurance processes. The work schedule is Monday to Friday, with potential overtime and weekend work based on business needs.
Job Responsibility:
Review and process insurance claims
Validate Member, Provider and other Claims 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
Requirements:
University degree or equivalent that required formal studies of the English language and basic Math
1-2 Year of experience where you had to apply business rules to varying fact situations and make appropriate decisions
1-2 Year of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product
1-2 Year of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
1-2 Year of experience that required prioritizing your workload to meet deadlines