HC and Insurance Operations Analyst

Must live in the Continental United States.

About the role

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.

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.
• 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.

Requirements

• 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.
• Minimum high school diploma or GED; college degree preferred.
• At least 1 year of experience working from home with proven productivity and quality.
• Designated quiet area for completing calls.
• Must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.
• Must pass drug screen and background check with education and employment verification.

Work Environment

• Remote work demands a dedicated, professional workspace conducive to servicing customers with minimal distractions.
• Workspace must be a permanent, unencumbered location used daily for work, ideally isolated from household members and used exclusively for job duties.
• Background noise, interruptions from people or pets, and other distractions must be kept to a minimum.
• Must work from the same location consistently unless prior approval is obtained.
• High-speed internet access with speeds at or above 50 Mbps and a hard-wired ethernet connection are required; Wi-Fi, mobile, wireless, and public internet connections are forbidden.
• NTT DATA will provide a computer and headset for remote work; employees are responsible for their care and security.
• Management monitors technical issues and agent downtime; chronic connectivity issues may result in a change from remote to onsite status.

Schedule

Required schedule availability is Monday-Friday, 7:00 am to 7:00 pm (Central Time). Overtime during evenings and Saturdays may also be required based on business need, particularly during November–February.

Pay

$26 per hour.

Benefits

• Medical, dental, and vision insurance with employer contribution.
• Flexible spending or health savings account.
• Life and AD&D insurance.
• Short- and long-term disability coverage.
• Paid time off.
• Employee assistance program.
• 401k program with company match.
• Additional voluntary or legally required benefits.
• State-specific certifications related to job duties will be sponsored by the company; successful completion is desired.