HC and Insurance Operations Analyst

Position

Medical Claims Case Manager:
Remote within the Continental United States

$22.00/hr

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, 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.

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.

• 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.

• Experience:
  • 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.
• Education: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.

• 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.
• Fraud Detection:Identify and flag potential fraudulent activities.
• 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.
• Collaboration:Work with management and team members to address service issues and concerns.
• Empathy:Communicate with claimants with empathy and a willingness to help.

Required schedule availability for this position is between Monday-Friday 7:00 am to 7:00 pm (Central Time), OT during evenings and Saturdays could also be required based on business need, particularly during the months of Nov – Feb.

To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.

Technology

• NTT DATA will provide a computer and headset for remote work.
• Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols.
• Failure to return equipment may result in collection actions and/or other consequences.
• Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.
• A hard‑wired ethernet connection is required. Wi‑Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling…