HC & Insurance Operations Senior Rep.

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.

Pay for this role is $17.00hr

Basic Qualifications:

• 6 Months of experience in claims adjudication, insurance operations, or related roles
• Experience in healthcare, disability, life, auto, or property & casualty claims (preferred, role dependent)
• 6 Months of Work from home environment
• High school diploma or GED Preferences.
  
  

Responsibilities:

• Review and adjudicate insurance claims to determine eligibility, coverage, and payment accuracy
• Interpret policy language, benefits schedules, and governing regulations to ensure correct claim outcomes
• Analyze claim documentation and supporting materials to verify completeness and accuracy
• Identify discrepancies, missing information, or potential fraud and take appropriate action
• Communicate claim decisions clearly to customers, providers, and internal stakeholders
• Ensure claims are processed within defined service level agreements (SLAs)
• Maintain accurate claim records and documentation in claims processing systems
• Collaborate with quality, compliance, and audit teams to support continuous improvement
• Strong attention to detail and analytical skills
• Solid understanding of insurance policies, benefits, and claims procedures
• Ability to interpret complex regulations and contractual language
• Effective written and verbal communication skills
• Ability to manage high claim volumes in a fast-paced environment
• Proficiency with claims processing systems and Microsoft Office tools
• Strong problem-solving and decision-making abilities
  
  

Adhere to privacy, confidentiality, and regulatory standards at all times

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.

Required schedule availability for this position is Monday-Friday 6:00 am ct to 6:00 pm (Central Time),

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