Senior Claims Processing 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

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

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

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

New

Customer Care Senior Representative

Location

Philippines , Quezon

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

New

Customer Care Senior Representative

Join our team as a Senior Customer Care Representative! Leverage your expertise ...

Location

Philippines , Quezon

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

Enrollment Representative Senior - HP Enrollment Eligibility

The Health Plan Enrollment Representative Senior will prioritize and coordinate ...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma required
Common Access Card (CAC) - be obtained within 6 months and kept current required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Provide application assistance and facilitate enrollment of eligible members and community members health insurance programs
Maintain knowledge and expertise in eligibility, enrollment and billing
and program specifications for U.S. Family Health Plan, Medicare, Medicaid, and or the Federal marketplace
Enrollment activities for members via paper, file transfer, or internet enrollment processing
Consistently meet and exceed Service Level Agreements related to enrollment and disenrollment process
Maintain detailed tracking of each function within the enrollment and disenrollment process including correspondence and accuracy of member ID cards
Communicates verbally and in writing with members, third parties and other departments as required to facilitate the enrollment, disenrollment and billing processes
Responds to internal and external customer inquiries regarding eligibility and related functions
Enters information during the enrollment process that assists claims personnel in claim adjudication including COB

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

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Senior Claims Processing Representative

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