Coverage Determination Representative I, Remote

JobDiva, Inc.; Woonsocket (RI); Remote; USD 25,000 - 39,000; Full time

Job summary

NTT DATA is seeking a Coverage Determination Rep I to join our team remotely in the US. The role focuses on Medicare Prior Authorization case reviews using multiple software systems, with emphasis on meeting government timelines and maintaining quality standards.

Responsibilities include triaging data-entry queues, researching reports, maintaining accurate documentation, and escalating issues to pharmacists or management as needed.

Qualifications

• 1 year minimum, medical insurance background.

Responsibilities

• Review Fax documents appropriately and forward to appropriate queues
• Update and maintain knowledge of relevant process, regulation and clinical material.
• Provide assistance or guidance in partnership with learning and innovation when needed
• Participate in developmental discussions receiving feedback with Supervisor

Skills

Medicare Prior Authorization

Data entry

Education

High School diploma or GED

Job description

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

For more than 25 years,NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

NTT DATA Services currently seeks several Coverage Determination Rep I to join our team working 100% Remote in the US.

Start date: 11/16/2026

Shift: Training Hours are 9a-5:30p EST. Working hours will be a rotating shift between the hours of 8a-8p EST

Job Summary:

In this role, Coverage Determination Representative I, contractors will be responsible for:

• Utilizing multiple software systems to create Medicare Prior Authorization case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity, and quality standards
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidanceQuestionnaire:

Position Summary:

The Coverage Determination/Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I's primary responsibilities will be to review each document with accuracy and place the case in the proper queues.

Further responsibilities include researching reports, maintaining complete, timely and accurate documentation of Coverage Determination/Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed.

Position will require schedule flexibility including rotations through Nights, Weekends and Holiday Coverage. All other duties are required to meet business needs.

Responsibilities

• Review Fax documents appropriately and forward to appropriate queues
• Update and maintain knowledge of relevant process, regulation and clinical material.
• Provide assistance or guidance in partnership with learning and innovation when needed
• Participate in developmental discussions receiving feedback with Supervisor

Experience:

• 1 year minimum, medical insurance background

Education:

High School diploma or GED

About NTT Data :

NTT DATA is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.

NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.

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