Senior Claims Processing Representative Job at NTT DATA (Plano)

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

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

Healthcare Claims Processing Senior Representative

The Healthcare Claims Processing Senior Representative at NTT DATA is responsibl...

Location

United States , Plano

Salary:

18.00 USD / Hour

NTT DATA

Expiration Date

Until further notice

Requirements

1-3 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.
Must be able to work 7am - 4 pm CST online/remote (training is required on-camera).
Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities

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

What we offer

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

Fulltime

Temp Bpo Senior Representative

Processing of Professional and Hospital claim form files by provider. Reviewing ...

Location

United States , Eden Prairie

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

2+ year of recent provider billing/coding experience or medical claims processing experience
2+ year of recent experience working with MS office products like – Outlook, MS Word, and MS Excel
Must be able and willing to learn new software tools and computer systems
Effective troubleshooting skills, where you can leverage your research, analysis, and critical thinking skills
Must have strong attention to detail and accuracy
High School Diploma or GED is required

Job Responsibility

Processing of Professional and Hospital claim form 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 and guidelines
Sustaining and meeting the client productivity/ quality targets to avoid penalties
Maintaining and sustaining quality scores above 9.5% PA and 99.75% FA
Timely response and resolution of claims received via email as priority work

Fulltime

New

People and Culture Manager

This role provides strategic People & Culture guidance and oversight for human r...

Location

United States of America , Westlake Village, California

Salary:

85000.00 - 90000.00 USD / Year

Four Seasons

Expiration Date

Until further notice

Requirements

High school diploma or GED
2 years experience in the People and Culture, management operations, or related professional area
or 2-year degree from an accredited university in Human Resources, Business Administration, or related major
1 year experience in People and Culture, management operations, or related professional area
Candidate must be able to thrive in a fluid environment, with a spirit for serving our employees and guests
Fluent in English and Spanish preferred
Skilled at Microsoft Office programs, Word, Excel, Canva (or similar application), and has the ability to quickly learn the HRIS
Embraces being detail-oriented (quality), highly efficient (speed) and strong follow up skills
Open to learning and participating in a dynamic, team atmosphere and maintain confidentiality
Strong critical thinking skills and problem solving skills

Job Responsibility

Oversees and ensures effectiveness of employee communication strategies and channels
Reviews and provides guidance on employee discipline and corrective action, including making recommendations to leadership on appropriate outcomes
Leads complex workplace internal audits and provides findings and recommendations to senior leadership
Maintains detailed investigation records
Utilizes an open door policy to acknowledge employee concerns in a timely manner
Advises managers and leadership on resolution of employee relations issues and escalates high-risk matters as appropriate
Partners with Security to conduct employee accident investigations, as necessary
Communicates performance expectations in accordance with job descriptions for each position
Oversees recruitment strategy and supports leadership in workforce planning and talent acquisition decisions
Provides guidance to management on candidate selection processes and hiring decisions

Fulltime

Senior Claims Representative

The Senior Claims Representative manages high priority accounts and catastrophic...

Location

United States , Carmel

Salary:

Not provided

Brown & Brown UK

Expiration Date

Until further notice

Requirements

Associate’s or Bachelor’s degree in business, financial related discipline, or Human Resources (preferred)
Proficient with Microsoft, Windows, Excel, IVOS, etc.
Exceptional telephone demeanor
Ability to maintain a high level of confidentiality
3 – 5 years’ experience in similar position
Insurance and/or Industry certification or designation

Job Responsibility

Maintain a claim inventory as deemed appropriate by management
Verify, research evaluate and make recommendations on appropriate coverage on each claim, using discretionary judgment
Make timely contact with members, injured workers, agents, providers, attorneys, etc.
Investigate claim with phone interviews/emails and obtain appropriate documentation
Evaluate exposure and adjust reserves as required
Conclude claim processing in accordance with company standards
Meet with members, agents, injured workers, attorneys, etc. as deemed necessary
Provide training and act as a mentor for members and other claims personnel
Travel to annual workers compensation conference and/or attend educational seminars
Other job-related projects or assignments as delegated

What we offer

Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
Financial Benefits: ESPP
401k
Student Loan Assistance
Tuition Reimbursement
Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more

Fulltime

Senior Workers’ Compensation Claim Representative

This is an on-site, full-time temporary role. The Senior Workers’ Compensation C...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Certification to handle California Workers’ Compensation claims is required
Minimum experience in lost time claims handling or similar fields (healthcare, disability, auto injury, etc.)
Working knowledge of California workers' compensation statutes and compliance regulations
Proficiency in Microsoft Office and familiarity with medical terminology and bill processing
Ability to analyze data and incorporate insights into claim resolution
Strong written and verbal communication skills
Must obtain applicable resident/designated home state adjuster license if not already held

Job Responsibility

Manage workers' compensation lost time claims from start to closure
Conduct comprehensive investigations and evaluate compensability
Communicate claim decisions to insureds, claimants, and attorneys
Administer statutory medical and indemnity benefits throughout claim lifecycle
Set and adjust reserves within authority limits
Collaborate with attorneys on hearings and litigation strategies
Direct nurse case managers, rehabilitation vendors, and telephonic case managers
Ensure compliance with all statutory filing requirements
Pursue subrogation opportunities where applicable
Maintain detailed file notes and participate in claim reviews

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Global Claims Handler

Proactive and detail-oriented Claims Adjuster to join their Global Markets team ...

Location

United Kingdom , Glasgow

Salary:

33000.00 GBP / Year

Lawes Consulting Group

Expiration Date

Until further notice

Requirements

Demonstrated experience in claims handling
Knowledge of end-to-end claims processes
Experience building and managing relationships with brokers, clients, and external stakeholders
Strong negotiation and analytical skills
Clear and professional written and verbal communication skills
Proven ability to manage caseloads effectively
Customer-centric mindset
Professional qualifications such as ACII (or progress towards it) are advantageous

Job Responsibility

Oversee the full lifecycle of claims including coverage assessment, investigations, and evaluation
Negotiate fair settlements with policyholders, brokers, solicitors, and other stakeholders
Manage an individual caseload efficiently
Work with third-party vendors and service providers
Represent the company in internal and external meetings
Build and maintain strong client relationships
Provide support to senior adjusters, managers, and underwriters

Fulltime

Senior Claims Processing Representative

NTT DATA

Location:
United States , Plano

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 20, 2026

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