NTT

3 days ago

HC & Insurance Operations Processing Sr Rep

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 13 hours agoStatus: Live

Reposted: first listed 5 days ago

Job Summary

Process and review healthcare insurance claims for a client health plan, validating member and provider information and applying policy procedures to determine payment criteria. Coordinate claim benefits, scrutinize medical claim documents and settlements, and resolve complex cases within established guidelines. Maintain quality, productivity goals, and aging timeframes while building strong working knowledge of healthcare insurance products and processes, supporting end-to-end claims administration.

Location: Plano

Workplace: Onsite

Employment Type: Full time

Job Function: Insurance & Actuarial

Seniority: Mid level

Key Responsibilities

•Review and process insurance claims end to end.
•Validate member, provider, and claim information.
•Determine accurate payment criteria for clearing pending claims using defined policy and procedures.
•Coordinate claim benefits based on policy and procedure; scrutinize medical claim documents and settlements.
•Maintain productivity goals, quality standards, and aging timeframes; resolve complex situations following pre-established guidelines.

Key Requirements

•University degree (or equivalent) requiring formal studies of English language and basic Math.
•6+ months of experience applying business rules to varying fact situations to make appropriate decisions.
•6+ months of data entry experience with a focus on quality, attention to detail, accuracy, and accountability.
•6+ months of experience using a computer with Windows PC applications, including keyboard use, screen navigation, and learning new software tools.
•6+ months of experience prioritizing workload to meet deadlines.

Experience:HealthcareInsuranceData entryClaims processingBPO

Education:Bachelor's

Skills:Attention to detailAccuracyAccountabilityCommunicationPrioritization

Languages:English

Tech Stack:WindowsPC applications

Company Brief

NTT

Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.

Industry: Professional Services

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Established Company

Valuation: Public Company (Market Cap in USD)

Headquarters: London, United Kingdom

Founded: 1983

Website LinkedIn

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NTT