HC & Insurance Operations Associate

NTT DATA North America; Chennai; Hybrid; INR 165,000 - 248,000; Full time

Job summary

NTT DATA, Inc. in Chennai is seeking candidates for an Insurance Claims processing role. You will process claims timely and accurately, review medical and policy documents, apply client rules to decide claims while flagging trends and potential fraud.

Strong communication and analytic skills are essential, with flexibility to work shifts and overtime as required. The role emphasizes independence and teamwork, with opportunities to learn updated policies and procedures and contribute to meeting

Qualifications

• Undergraduates and postgraduates may apply.
• Excellent communication (verbal and written) and customer service skills.
• Able to work independently; strong analytic skills.
• Detail-oriented; ability to organize and multi-task.
• Ability to make decisions.
• Proficient with MS Office and data entry.
• Strong reading and writing skills.
• Willing to work in shifts (evenings) and overtime as required.

Responsibilities

• Process Insurance Claims timely and meet production, productivity and quality goals.
• Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities
• Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing
• Be a team player and work seamlessly with other team members on meeting customer goals

Skills

Communication skills

Analytical skills

Detail oriented

Decision making

Reading & writing

Team player

Adaptability

Education

Undergraduate or Postgraduate allowed

Tools

MS Office

Data entry

Web navigation

Word processing

Job description

• Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals


• Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities


• Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing


• Be a team player and work seamlessly with other team members on meeting customer goals

Positions General Duties and Tasks:

• Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals


• Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities


• Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing


• Be a team player and work seamlessly with other team members on meeting customer goals

Requirements for this role include:

• Both Under Graduates and Post Graduates can apply.


• Excellent communication (verbal and written) and customer service skills.


• Able to work independently; strong analytic skills.


• Detail-oriented; ability to organize and multi-task.


• Ability to make decisions.


• Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications.


• Demonstrate strong reading comprehension and writing skills.


• Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills.


• Ability to work in a team environment.


• Handling different Reports - IGO/NIGO and Production/Quality.


• To be in a position to handle training for new hires


• Work together with the team to come up with process improvements


• Strictly monitor the performance of all team members and ensure to report in case of any defaulters.


• Encourage the team to exceed their assigned targets.


• Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.

Requirements for this role include:

• Candidate should be flexible & support team during crisis period


• Should be confident, highly committed and result oriented


• Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools


• Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers


• Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product


• Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home.

Preferences for this role include:

• 3+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT.


• 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.