Medical Claims Processor Job at NTT DATA (Plano)

Bpo transaction quality assurance analyst

The BPO Transaction Quality Assurance Analyst will play a vital role in reviewin...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Any Bachelor’s degree
A minimum of 3 years of experience as a Transactional Quality Auditor/MIS specialist/Quality associate involved in implementation of basic Quality framework elements
Experience with Life Insurance Claims and Policy Administration
Demonstrates a strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specifications, and change management
Ability to collate data/information from different sources and work on Management Reports without any error
Excellent communication skills (written and verbal) to clearly articulate business requirements to technical & development teams
Knowledge of process mapping tools – MS Visio and Lucid Charts, Excel and Power Point
Lean Six Sigma
Experience working in an Agile environment
Experience with Salesforce or other case management systems' modernization

Job Responsibility

Review claims transactions and provide feedback to claims processors
Improve process efficiency & quality for existing and new processes through analysis and design of workflows and business processes
Review medical documents, policy documents, policy history, claims history, system notes and apply the trained client level business rules to ensure that processors make appropriate Claims decisions, call out claims trends and flag fraud activities
Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function
Perform functional analysis of the current business process and supporting documentation
Identify process improvements and facilitate reengineering of business processes
Create process and value stream map for existing and new business processes
Assist in establishing and maintaining standard operating procedures and knowledge transfer documentation on various functionalities
Be a team player and work seamlessly with other team members on meeting customer goals

Fulltime

Medical Claims Processor

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our...

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

Medical Claims Processor

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our...

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

Bpo transaction quality assurance analyst

The BPO Transaction Quality Assurance Analyst is responsible for reviewing claim...

Location

India , Chennai

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

Any Bachelor’s degree
A minimum of 3 years of experience as a Transactional Quality Auditor/MIS specialist/Quality associate involved in implementation of basic Quality framework elements
Experience with Life Insurance Claims and Policy Administration
Demonstrates a strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specifications, and change management
Ability to collate data/information from different sources and work on Management Reports without any error
Excellent communication skills (written and verbal) to clearly articulate business requirements to technical & development teams
Knowledge of process mapping tools – MS Visio and Lucid Charts, Excel and Power Point
Lean Six Sigma
Experience working in an Agile environment
Experience with Salesforce or other case management systems' modernization

Job Responsibility

Review medical documents, policy documents, policy history, claims history, system notes and apply the trained client level business rules to ensure that processors make appropriate Claims decisions, call out claims trends and flag fraud activities
Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function
Perform functional analysis of the current business process and supporting documentation
Identify process improvements and facilitate reengineering of business processes
Create process and value stream map for existing and new business processes
Assist in establishing and maintaining standard operating procedures and knowledge transfer documentation on various functionalities
Be a team player and work seamlessly with other team members on meeting customer goals

Fulltime

Senior Claims Processor

The Customer Experience Administrator (CEA) is a field-based role reporting to t...

Location

United States , Sparks

Salary:

18.00 - 24.00 USD / Hour

MillenniumSoft Inc

Expiration Date

Until further notice

Requirements

At least 5 years of experience in a customer service/customer facing role
High School diploma or equivalent
Must be proficient in Microsoft word, excel, PowerPoint and be able to utilize computer based tools for reports, email and general communication
Ability to work both individually and in team setting
Must be able to interface with customers, peers and support personnel in a positive manner as well as the ability to think and act in a logical and methodical way
Excellent verbal, written, and organizational skills
Good problem-solving and critical thinking skills
Flexibility to travel up to 50% of time outside of home geographic area, based upon business needs
Must be able to lift up to 30lbs frequently and up to 70lbs infrequently
Adhere to all PPE (Personal Protective Equipment) standards/guidelines required by company policy

Job Responsibility

Drive Net Promoter Scores (Customer Satisfaction) higher
Improve communication between customers and the Field Service Engineers
Follow up with customers after service has been completed to ensure that all needs were met or exceeded
Manage company assets including, cell phone, computer, tablet, etc
Establish and foster positive business relationships with customers and peers
Perform administrative duties including, but not limited to, recording time worked, training, etc
Provide ongoing feedback to customers in regards to instrument repair and status
Work closely with district team leads and dispatch to schedule and support customer base
Satisfactorily complete training in Salesforce, ServiceMax, and Qualtrics

Fulltime

Claims Processor

Are you ready to be part of a WINNing team at Winn Group, a leading North East b...

Location

United Kingdom , Newcastle

Salary:

26000.00 - 29000.00 GBP / Year

Winn Group

Expiration Date

Until further notice

Requirements

Attention to detail and accuracy
Time management and organisation skills
Experience of working towards deadlines and performance objectives
Experience of demonstrating effective teamworking within a commercial environment

Job Responsibility

Build a positive relationship with each client whilst processing the claim, helping manage their expectations and delivering the right outcome
Ensure accuracy in all aspects of Claims Processing including, but not limited to: Hire reviews, engineer reports and storage Instructions, total loss reports, Impecuniosity pre-checks and open banking signup and medical Instructions
Assisting Case Handlers with their claims to ensure the department is up to date
Accurately record any key FNOL information for Road Traffic Accident onto our case management system
Assisting with FRT incoming calls overflow

What we offer

25 days holiday plus bank holidays
Additional birthday holiday
Options to buy or sell holidays (subject to eligibility)
Funded learning initiatives
SQE Apprenticeships
Training Contracts (subject to application)
Flexible working hours
On-site parking (subject to availability)
Corporate Metro Scheme
Bike to Work Scheme

Fulltime

New

Data Entry Clerk

We are looking for a detail-oriented Data Entry Clerk to join our team on a cont...

Location

United States , Saint Paul

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience in data entry or a related field
Proficiency in numeric and text-based data entry
Strong typing skills with a focus on accuracy and speed
Familiarity with computer systems and data entry software
Ability to manage and organize large volumes of information efficiently
Excellent attention to detail and problem-solving skills
Effective communication skills to address discrepancies or collaborate with team members

Job Responsibility

Accurately input numeric and text-based data into computer systems and databases
Verify and cross-check data entries to ensure completeness and accuracy
Maintain organized records and ensure proper documentation of all data
Perform routine audits to identify and correct errors in data entries
Collaborate with team members to ensure smooth data flow and consistency
Manage large volumes of information while adhering to deadlines
Follow established procedures and protocols for data entry tasks
Communicate any discrepancies or issues with relevant departments
Utilize typing and data entry skills to meet daily productivity goals

What we offer

medical
vision
dental
life and disability insurance
company 401(k) plan

New

Security Operations Center Operator

The Security Operations Center (SOC) Operator is staffed twenty-four (24) hours ...

Location

United States , Mandan

Salary:

21.15 USD / Hour

Allied Universal®

Expiration Date

Until further notice

Requirements

Must be 21+ years of age
Minimum 6 months or more of Security experience required
Must possess a high school diploma or equivalent
Must possess one or more of the following: Service in Military Occupational Specialty related to law enforcement, security
Graduate of a Certified Public Safety Academy
Bachelor’s degree in protective services, business, or related field
A minimum of 8 or more years of active service in any military branch
Associate’s degree (or 60 credits) or higher in criminal justice with current or prior active military service
2 years of work experience in public sector dispatch or emergency operations center
2 years of verifiable data center security experience

Job Responsibility

Monitor all security, communications, and fire/life safety systems within the designated region
Proactively monitor all surveillance cameras and CCTV remote viewer programs
Answer and respond to events and situations received over regular and emergency phones and intercoms
Serve as the liaison between all departments and the security department
Handle complaints and unusual/critical event information
Accurately document routine and unusual events
Accurately maintain control of all equipment and keys in the Control Room
Complete “task work orders" for all reported maintenance needs
Inform the Shift Supervisor / Account Manager of any missing, damaged, or inoperative equipment
Control and monitor the two-way communication systems

What we offer

medical
dental
vision
401k
life insurance
Employee Assistance Program
Employee Discount Program
Tuition Discount Program
Training & Career Development Programs

Fulltime

Medical Claims Processor

NTT DATA

Location:
United States , Plano

Category:
IT - Administration

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 04, 2026

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