HC & Insurance Operations Associate
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Key skills for this role
About the Role
NTT DATA North America seeks an HC & Insurance Operations Associate to process adjudication claims for payment and denials. You will handle authorization, COB, duplicate, pricing, and corrected claims, ensuring accurate and timely completion to meet SLAs.
Key Skills for This Role
Responsibilities
- Process Adjudication claims and resolve for payment and Denials
- Handle authorization, COB, duplicate, pricing and corrected claims process
- Ensure accurate and timely completion of transactions to meet or exceed client SLAs
- Organize and complete tasks according to assigned priorities
- Develop and maintain a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
- Resolve complex situations following pre established guidelines
Requirements
- 1 3 years of experience in processing claims adjudication and adjustment process
- Experience of Facets is an added advantage
- Good communication (Demonstrate strong reading comprehension and writing skills)
- Able to work independently, strong analytic skills
- Required schedule availability for Monday Friday 5.30PM/3.30AM IST (AR SHIFT)
Full Job Posting
Roles and Responsibilities
- Process Adjudication claims and resolve for payment and Denials
- Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
- Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co pay, out of pocket, maximum inside limits and exclusions, state variations
- Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
- Organizing and completing tasks according to assigned priorities.
- Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
- Resolving complex situations following pre established guidelines
Requirements
- 1 3 years of experience in processing claims adjudication and adjustment process
- Experience of Facets is an added advantage.
- Experience in professional (HCFA), institutional (UB) claims (optional)
- Both under graduates and post graduates can apply
- Good communication (Demonstrate strong reading comprehension and writing skills)
- Able to work independently, strong analytic skills
- Required schedule availability for this position is Monday Friday 5.30PM/3.30AM IST (AR SHIFT). 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.
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