HC & Insurance Ops Analyst

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.
  
  

If you are passionate about delivering exceptional customer service and have the required qualifications, we encourage you to apply for this rewarding opportunity.

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