Req ID: 232131

NTT DATA Services 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 HC & Insurance Operations Senior Rep to join our team in Plano, Texas (US-TX), United States (US).

• 2 years medical insurance claims processing or 1 year Medicare or Medicare Advantage claims processing

• 1 year Microsoft Office Suite experience

• 1 year CPC, CPB or CMRS experience

• Identifies and resolves issues around pending transactions
• Ability to analyze reasons behind incomplete transactions
• Understands process interdependencies
• Check for completeness and appropriateness of source data
• To perform initial fact finding, information search and data gathering
• Identify and resolve routine and recurring claim transactions
• Maintain current knowledge of CMS compliance requirements as they pertain to Medicare Advantage claim adjudication
• Research incomplete and missing information by utilizing several internal systems
• Interpret and apply desk level procedures to accurately adjudicate claims data
• Identify complex or out of compliance cases for escalation

NTT DATA Services is a global business and IT services provider specializing in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services. We are part of the NTT family of companies, a partner to 85 % of the Fortune 100.

NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Job Segment: Consulting, Technology