HC and Insurance Operations Analyst

NTT DATA Services; Oregon; Hybrid; USD 30,000 - 42,000; Full time

Benefits offered by this job

Medical, dental, vision insurance with

Employer 401k match

Paid time off

Flexible spending account / HSA

Life and AD&D insurance

Short- and long-term disability

Employee assistance

Job summary

NTT DATA, Inc. is seeking a Claims Case Manager to manage the full lifecycle of insurance claims from intake to resolution. The role emphasizes empathetic communication, attention to detail, and timely status updates to claimants via email, phone, and mail.

Qualified candidates will have at least 2 years in analytical claims roles, 2 years in claims adjudication, and 4 years reviewing medical records. Remote work is supported with required home workspace and tech setup.

Qualifications

• 2 years in an analytical role reviewing medical benefits and claims.
• 2 years of claims adjudication experience, preferably in life and supplemental products.
• 4 years of experience reviewing and assessing medical records.

Responsibilities

• End-to-End Claim Management from intake to final decision.
• Provide frequent updates to claimants through email, phone, and mail.
• Review medical documents, claim forms, and policy notes for accuracy.
• Interact with claimants with empathy and attention to detail.
• Collaborate with team members to ensure high-quality service and resolution of issues.
• Maintain accurate records and reports throughout the claims process.
• Analyze data to identify trends and perform root cause analysis.
• Initiate claims and log updates through the lifecycle.
• Communicate required medical records and claim information via multiple channels.
• Follow up on pending claims and assist in obtaining necessary medical records.
• Calculate benefit amounts and process payments in the claims system.
• Manage a caseload of active claims and perform end-to-end steps.

Skills

Analytical skills

Empathy and communication

Attention to detail

Multitasking

Education

High School diploma or GED

College degree preferred

Job description

Position: Claims Case Manager

Must live in the Continental United States

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.

Pay for this Role $26hr.

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.

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.

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. Identify and flag potential fraudulent activities.

Collaboration

Work with management and team members to address service issues and concerns.

Empathy

Communicate with claimants with empathy and a willingness to help.

Any state specific certification related to performing the job duties shall be sponsored by the company and successful completion of the certification program is desired.

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.

Remote Working and Technology Requirements

To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.

Technology

NTT DATA will provide a computer and headset for remote work.Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols.Failure to return equipment may result in collection actions and/or other consequences.Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.A hard-wired ethernet connection is required. Wi‑Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location.

Technical Performance and Issue Tracking

Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations.Remote employees must adhere to all technical support procedures and protocols.Chronic connectivity issues or recurring downtime that impede job performance, including internet outages, may result in the remote status changing to onsite.

Remote Workspace

Remote work demands a high degree of professionalism, self‑discipline, and accountability. The following workspace standards are vital to delivering exceptional service.Employees must have a dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment.The workspace must be a permanent, unencumbered location used daily for work.Employees must work with minimal distractions that do not interfere with business operations or service delivery.Ideally, the workspace is isolated from other household members and used exclusively for job duties.Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service.Employees must work from the same location consistently unless prior approval is obtained. If a change in work location is necessary: The new location must meet all Remote Workspace and Technology Requirements. Notification to NTT DATA Management is required before relocating.