Claims Case Management Specialist

3 days ago

Lincoln, Nebraska, United States NTT DATA Full time
About the Role

We are seeking a skilled Claims Case Management Specialist to join our team at NTT DATA.

This is an excellent opportunity for individuals with a strong analytical background and excellent communication skills.

Job Description

The Claims Case Management Specialist will be responsible for providing end-to-end claim servicing to Insurance policyholders, from intake to final decision.

You will review medical documents, claim forms, and policy notes extensively, utilizing your high analytical skill set.

A thorough understanding of the entire life cycle of claims process and the related system is key to being a successful case manager.

Communicating with great empathy and the level of details in each opportunity to interact with the claimant is extremely critical for the desired level of outcome.

You will also provide frequent status updates of the claim to the claimant through their preferred communication channel, which includes email, phone, mail, etc.

Responsibilities
  • Initiating of claim through various input channels including gathering of information over the phone.
  • Detailed inputs to log and update pertinent information throughout the lifecycle of the claim.
  • Thorough review of claims documents to determine applicable benefits and all relevant information required to finalize the claim.
  • Omni Channel Correspondence (E-Mail/Mail/Call) to articulate the required medical records and claim information to make a final decision on the claim.
  • Frequent follow through on pending claims in a proactive manner and offer assistance to gather required medical records.
  • Review trends and apply business analytics to determine ongoing payments for existing claims but also flag for any fraudulent activities.
  • Calculate the benefit amount payable across all applicable benefits and apply the business rules to process the payment through the Claims system.
Requirements

To be successful as a Claims Case Management Specialist, you will need:

  • 2 years in an analytical role in reviewing medical benefits and claims.
  • 2 years Claims Adjudication Experience preferably in Medical Supplemental products including Critical Illnesses such as cancer, stroke, heart attack, kidney disease, etc.
  • 4 years experience of reviewing and assessing medical records.
  • Experience in a job where the candidate had to understand and verbally articulate the requirements to finalize a claim in a concise and clear manner.
  • Minimum High school diploma or GED.
What We Offer

We offer a competitive salary of $22.00/hr and a range of benefits, including medical, dental, and vision insurance, flexible spending or health savings account, life and AD&D insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

As a member of our team, you will have the opportunity to work in a dynamic and inclusive environment with a diverse group of experts.

We strive to hire exceptional, innovative, and passionate individuals who want to grow with us.

NTT DATA is an equal opportunity employer and considers all applicants without regard 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.

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