HC & Insurance Operations Senior Rep

1 month ago


Noida, Uttar Pradesh, India NTT DATA Services Full time

In this Role you will be Responsible For

Review & Processes Healthcare payer claims including HCFA & UB forms.

Validate Member, Provider and other Claims information.

Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.

Coordination of Claim Benefits based on the Policy & Procedure.

Maintain productivity goals, quality standards and aging timeframes.

Scrutinizing Medical Claim Documents and settlements.

Organizing and completing tasks per assigned priorities.

Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea

Resolving complex situations following pre-established guidelines

Requirements for this role include:

University degree or equivalent that required formal studies of the English language and basic Math

3+ Year of experience where you had to apply business rules to varying fact situations and make appropriate decisions

3+ Year of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.

3+ Year of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.

3+ Year of experience that required prioritizing your workload to meet deadlines



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