Healthcare Claims Processing Senior Representative Job at NTT DATA (Plano)

Healthcare Claims Processing Senior Representative

The Healthcare Claims Processing Senior Representative will be responsible for p...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
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.

Job Responsibility

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

Senior Claims Processing Representative

The Senior Claims Processing Representative role at NTT DATA involves processing...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
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.

Job Responsibility

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

Operations Processing Senior Representative

Join our team as a Senior Customer Care Representative and make a real impact by...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Proficiency in Microsoft office programs and general computer operations
Ability to learn and follow basic direction on process
Must have mastery of the English language, both oral and written
Must be detail-oriented and organized to maintain accurate records
Must have the ability to focus and work quickly
Able to work independently
Sense of urgency in reporting any concerns to immediate supervisor
High School diploma or equivalent required
1-2 years’ experience working in the medical field preferred

Job Responsibility

Performs timely and accurate review of electronic records/documentation scanning for completeness of submissions in accordance with established policies
Identifies opportunities and reports on inaccuracies that may be present in reviewed documents
Learns CRM system and is able to access different internal online resources to obtain required information in a timely manner
Performing inbound and outbound calls to insurance companies, medical facilities and customers in the US
Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met
Analyzing medical insurance claims for quality assurance
Resolving moderately routine questions following pre-established guidelines
Performing routine research on customer inquiries
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

Fulltime

Customer Care Collections Senior Representative

The Senior Customer Care Collections Representative is responsible for performin...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Ability to work regularly scheduled shifts from Monday-Friday according to US time
High school diploma
1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
0-6 months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English
0-6 months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions

Job Responsibility

Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables
Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met
Analyzing medical insurance claims for quality assurance
Resolving moderately routine questions following pre-established guidelines
Performing routine research on customer inquiries
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

Fulltime

Quality Review and Audit Senior Representative

This position will be responsible for auditing the work within the CGHB Organiza...

Location

India , Bengaluru

Salary:

Not provided

The Cigna Group

Expiration Date

Until further notice

Requirements

2+ years of overall experience processing claims
at least 1+ year Diamond claim processing experience required
US & International claims experience preferred
Customer Service Driven
ability to meet and exceed the internal partner and external customer expectations
Proven outcomes in critical thinking and decision-making outcomes
Proven outcomes in problem solving skills
utilization of technical skills and resources to ensure accuracy of final resolution
Proven process improvement skills: ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
Must be comfortable and effective working in a diverse environment

Job Responsibility

Completes audits to ensure claim advocates understanding of current Cigna policies and procedures, including job aids, Articles, and alerts
Interfaces with matrix partners in relation to quality audit process, specifically address gaps identified through audit process and recommendations for gap closure
Completes review of documents related to audits to help ensure direction is clear and consistent with processing of work
Provides feedback to operations where updates may be required to drive consistency and accuracy
Completes inter-rater reliability exercises with peers, other quality roles and business owners to provide insight into review process
Excellent skills in navigation and use of all applications related to Diamond claim role including but not limited to: Diamond, SAM3, Outlook, CPF, Network X-Pricer, Salesforce, I Provider, Envoy, Facets, Visium, X-Net, Knowledge Xchange, PIMS (SANP), etc
Provides a quality review voice in various workgroups pertaining to workflows, documentation and issues driving errors, in an attempt to continuously improve results
Supports, educates, and reinforces the workflows, processes, tools for the nurses
Provides support for internal and GSP sites based on business needs
Support Coaching and Training program and responsibilities when needed to Support for Business needs and requirements which could include answering Q&A, facilitate trainings, and Coaching’s

BPO Customer Care Collections Senior Representative

The Senior BPO Customer Care Collections Representative is responsible for manag...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Ability to work regularly scheduled shifts from Monday-Friday according to US time
High school diploma
1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
0-6 months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English
0-6 months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions

Job Responsibility

Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables
Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met
Analyzing medical insurance claims for quality assurance
Resolving moderately routine questions following pre-established guidelines
Performing routine research on customer inquiries
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

Customer care collections senior representative

The Senior BPO Customer Care Collections Representative will be responsible for ...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Ability to work regularly scheduled shifts from Monday-Friday according to US time
High school diploma
1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
0-6 months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English
0-6 months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions

Job Responsibility

Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables
Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met
Analyzing medical insurance claims for quality assurance
Resolving moderately routine questions following pre-established guidelines
Performing routine research on customer inquiries
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

BPO Customer Care Collections Senior Representative

The Senior BPO Customer Care Collections Representative is responsible for manag...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Ability to work regularly scheduled shifts from Monday-Friday according to US time
High school diploma
1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
0-6 months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English
0-6 months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions

Job Responsibility

Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables
Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met
Analyzing medical insurance claims for quality assurance
Resolving moderately routine questions following pre-established guidelines
Performing routine research on customer inquiries
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

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Healthcare Claims Processing Senior Representative

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