BPO HC and Insurance Operations Analyst

NTT DATA North America; Lincoln (NE); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Claims Case Manager to join their team. In this role, you will manage the entire claims process, ensuring effective communication with policyholders and providing updates throughout. The ideal candidate will possess strong analytical skills and a deep understanding of the claims process, coupled with the ability to communicate with empathy and detail. This position offers a supportive work environment with comprehensive benefits, including medical, dental, and vision insurance, as well as a 401k program with company match. If you're passionate about delivering exceptional customer service and have the required qualifications, this is a rewarding opportunity to grow your career.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k Program with Company Match

Paid Time Off

Employee Assistance Program

Qualifications

• 2 years in an analytical role reviewing medical benefits and claims.
• 4 years of experience reviewing and assessing medical records.

Responsibilities

• Manage the entire claims process from intake to final decision.
• Provide frequent updates to claimants through preferred communication channels.
• Compile and analyze data to identify trends and perform root cause analysis.

Skills

Analytical Skills

Communication Skills

Empathy

Attention to Detail

Multitasking

Education

High School Diploma or GED

College Degree

Job description

Req ID:311172

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a BPO HC and Insurance Operations Analyst to join our team.

Position: Claims Case Manager

Pay: $22.00/hr

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, 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.

Role Overview: We are seeking a dedicated Claims Case Manager to provide comprehensive claim servicing to our insurance policyholders. This role involves managing the entire claims process from intake to final decision, ensuring frequent status updates to claimants through their preferred communication channels (email, phone, mail, etc.). The ideal candidate will have a strong analytical skill set, a thorough understanding of the claims process, and the ability to communicate with empathy and detail.

Key Responsibilities:

• End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision.
• Status Updates: Provide frequent updates to claimants through their preferred communication channels.
• Document Review: Thoroughly review medical documents, claim forms, and policy notes.
• Communication: Interact with claimants with empathy and attention to detail.
• Team Collaboration: Work with team members to ensure high-quality service and resolution of issues.
• Record Keeping: Maintain accurate records and reports throughout the claims process.
• Data Analysis: Compile and analyze data to identify trends and perform root cause analysis.

Basic Qualifications:

• Experience:
  • 2 years in an analytical role reviewing medical benefits and claims.
  • 2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease).
  • 4 years of experience reviewing and assessing medical records.
  • Experience articulating claim requirements clearly and concisely.
• Education: Minimum high school diploma or GED; college degree preferred.
• Work Environment:
  • At least 1 year of experience working from home with proven productivity and quality.
  • Designated quiet area for completing calls.

Additional Responsibilities:

• Claim Initiation: Gather information and initiate claims through various channels.
• Detailed Logging: Log and update pertinent information throughout the claim lifecycle.
• Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone.
• Proactive Follow-Up: Follow up on pending claims and assist in gathering required medical records.
• Benefit Calculation: Calculate benefit amounts and process payments through the claims system.
• Fraud Detection: Identify and flag potential fraudulent activities.
• Multitasking: Manage a caseload of active claims and perform end-to-end steps.
• Attention to Detail: Ensure accuracy and organization in logging, tracking, and reviewing claims.
• Collaboration: Work with management and team members to address service issues and concerns.
• Empathy: Communicate with claimants with empathy and a willingness to help.

If you are passionate about delivering exceptional customer service and have the required qualifications, we encourage you to apply for this rewarding opportunity.

Required schedule availability for this position is between Monday-Friday 7:00 am to 7:00 pm (Central Time). OT during evenings and Saturdays could also be required based on business need, particularly during the months of Nov – Feb.

New hire must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.

Must pass drug screen.

Must pass a background check with education check and employment verification check.

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