• Review the Family Medical Leave Act (FMLA), state, company and other absence certifications as mandated by state and federal guidelines and in coordination with our customer’s policies • Provide accurate, professional, and timely responses to communications from internal and external partners • Contact medical providers to obtain or clarify medical facts supporting the need for a leave of absence • Maintain complete and accurate documentation of leaves within our proprietary database • Correspond with clients regarding leave status and assist with decision making • Process reports for clients and short term disability partners • Input and analyze data • Demonstrate respect, sensitivity, and confidentiality, while maintaining professionalism at all times • Meet and adhere to production and quality goals as well as performance metrics • Responsible and accountable for maintaining and protecting personal, confidential claimant health information • Must maintain a high level of confidentiality and abide by HIPAA rules and regulations • Engage in ongoing education and training around laws, policies and service delivery • Support management with special projects as necessary • Other duties as assigned

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment

• Analyze complex or technically difficult general liability claims to determine damages • Work with high exposure claims involving litigation • Ensure ongoing adjudication of claims within service expectations, industry best practices and client service requirements • Identify risk transfer opportunities and negotiate settlements • Manage claims through well-developed action plans to resolution • Assess liability and resolve claims within evaluation • Negotiate settlement of claims • Calculate and assign timely and appropriate reserves to claims • Manage the litigation process and ensure timely claims resolution • Coordinate vendor referrals for additional investigation and/or litigation management • Use cost containment techniques to reduce overall claims cost • Report claims to the excess carrier and respond to requests • Communicate claim activity with the claimant and client

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.