Rep II, Operations Specialist

4 weeks ago


Providence, Rhode Island, United States NTT DATA Full time
Job Summary

We are seeking a highly skilled and detail-oriented Rep II, Operations to join our team at NTT DATA Services. As a key member of our operations team, you will be responsible for handling Medicare appeals case reviews, working virtually, and utilizing multiple software systems to ensure timely and accurate resolution of cases.

Key Responsibilities
  • Conduct thorough reviews of Medicare appeals cases to ensure compliance with government regulations and company policies.
  • Utilize multiple software systems to complete case reviews and communicate with beneficiaries and providers.
  • Meet or exceed government-mandated timelines for case resolution.
  • Comply with turnaround time, productivity, and quality standards.
  • Communicate effectively with beneficiaries and providers to convey resolution and provide excellent customer service.
Requirements
  • At least two years of general business experience with a focus on problem resolution, business writing, quality improvement, and customer service.
  • Six months of experience working in a virtual role with a supervisor not physically present.
  • Six months of experience in PBM/pharmaceutical benefits related work.
  • Six months of experience in a high-volume call center environment.
Preferred Qualifications
  • Ability to work independently with minimal supervision.
  • Technical skills to troubleshoot and communicate technical issues to leaders or IT.
  • Effective communication skills to manage multiple software systems and communicate with beneficiaries and providers.
  • Accountability and results-driven with a focus on meeting deadlines and delivering high-quality results.
About NTT DATA Services

NTT DATA Services is a recognized leader in IT and business services, including cloud, data, and applications. As part of NTT DATA, a $30 billion trusted global innovator, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration, and global data centers. We are committed to our clients' long-term success and creating a diverse and inclusive environment for all employees.



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