HC & Insurance Operations Processing Sr Rep

About the Role

NTT DATA is partnering with a leading US health plan in Florida to manage end-to-end claims administration services. As a BPO HC & Insurance Operations Senior Representative, you will help streamline operations, improve productivity, and strengthen cash flow to enhance member satisfaction and competitiveness.

Responsibilities

• Review and process insurance claims.
• Validate member, provider, and other claim information.
• Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
• Coordinate claim benefits according to policy and procedure.
• Maintain productivity goals, quality standards, and aging timeframes.
• Scrutinize medical claim documents and settlements.
• Organize and complete tasks per assigned priorities.
• Develop and maintain solid working knowledge of the healthcare insurance industry, including all products, services, and team processes.
• Resolve complex situations following pre-established guidelines.

Requirements

• University degree or equivalent that required formal studies of the English language and basic math.
• 6+ months of experience applying business rules to varying fact situations and making appropriate decisions.
• 6+ months of data entry experience with a focus on quality, including attention to detail, accuracy, and accountability.
• 6+ months of experience using a Windows PC, including keyboard use, screen navigation, and learning new software tools.
• 6+ months of experience prioritizing workloads to meet deadlines.

Preferences

• Ability to communicate effectively (oral/written) to exchange information with clients.
• Commerce graduate with English as a compulsory subject.

Schedule

Required availability: Monday–Friday, 06:00 PM to 04:00 AM IST. Shift timings may change based on client requirements. Overtime and weekend work may be required as needed.