Req ID: 300705

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 SR. Claims Case Management to join our team.

SR. Claims Case Management,

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.

• 3 years in an analytical role in reviewing medical benefits and claims.
• 2 years Claims Adjudication Experience preferably in Life, Annuity and Supplemental products including Critical Illnesses such as cancer, stroke, heart attack, kidney disease, etc is desired.
• 5 years experience of reviewing and assessing medical records.
• Experience in a job where the candidate had to understand and verbally articulate the requirements to finalize a claim in a concise and clear manner is vital for this role.+
• Minimum High school diploma or GED.

• Initiating of claim through various input channels including gathering of information over the phone.
• 1 year experience in work from home set up delivering desired level of Productivity & Quality.
• College Degree Preferred.
• Detailed inputs to log and update pertinent information throughout the lifecycle of the claim.
• Thorough review of claims documents to determine applicable benefits and all relevant information required to finalize the claim.
• Omni Channel Correspondence (E-Mail/Mail/Call) to articulate the required medical records and claim information to make a final decision on the claim.
• Frequent follow through on pending claims in a proactive manner and offer assistance to gather required medical records
• Review the incoming medical records and appropriately tag them to the inventory of pending claims and perform a thorough review to calibrate on true outstanding requirements
• Perform a detailed review to identify applicable benefits, review of related certificate language and all medical records as part of claims adjudication.
• Review trends and apply business analytics to determine ongoing payments for existing claims but also flag for any fraudulent activities.
• Calculate the benefit amount payable across all applicable benefits and apply the business rules to process the payment through the Claims system.
• Refer the dollar threshold matrix to determine the claims that needs to be sent for additional review and instantly make corrections if there are errors reported.
• Ability to multitask for managing a caseload of claims active inventory and perform end to end steps right from Intake to Finalizing a claim.
• Attention to detail and organization to log, track, review and claims in the required turnaround time.
• Collaborating with management or other team members as appropriate to proactively address service issues and concerns.
• Demonstrated ability to fully own end to end resolution and handle all the tasks related to that claim with great detail and accuracy.
• Designated quiet area to complete calls while working from home.
• Verbally correspond with extreme empathy and willingness to help.