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HC & Insurance Operations Processing Sr Rep
Location
United States
Posted
72 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
HC & Insurance Operations Processing Sr Rep
NTT DATA Services, LLC
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
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Principal, System Operations Manager
Gainwell TechnologiesGainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past
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What were looking for - Bachelor’s degree in Computer Science, Information Systems, Engineering, or related field (Master’s or PMP preferred). - 10+ years in IT systems engineering, operations, or infrastructure leadership (Medicare MIS or healthcare platform experience preferred). - 5+ years in technical and service delivery leadership roles. - Deep expertise in ITIL4, ITSM, and technical project execution within complex, regulated environments. - Knowledge of HIPAA, SOC, and enterprise compliance frameworks. What you should expect in this role - United States remote opportunity - Video cameras must be used during all interviews, as well as during the initial week of orientation - The Deadline to submit applications for this posting is March 24, 2026 The pay range for this position is $99,000.00 - $141,400.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
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Cloud Operations Specialist
Blue Cross Life / Croix Bleue VieBlue Cross Life Insurance Company of Canada (Blue Cross Life) takes great pride in being the most trusted brand by Canadian consumers, offering exceptional coverage tailored to protect them and their families. Federally licensed with operations across Canada, Blue Cross Life provides a full suite of top-tier Individual and Group Life and Disability insurance options. This comprehensive range of products is backed by an insurer with decades of experience protecting Canadians. Our employees are the key component in enabling us to deliver competitive life and disability products nationally; we value their knowledge and integrity and are dedicated to their professional development by providing an environment of continuous learning and growth. We seek creative problem solvers who care about the work they do while helping to drive responsiveness and insight throughout our organization. If you are looking for an opportunity in a challenging, fast-paced, and collaborative work environment, the career you have been looking for may be waiting for you at Blue Cross Life.
Position Type: Permanent As one of Canada’s leading life insurers, Blue Cross Life Insurance Company of Canada (Blue Cross Life) takes great pride in being the most trusted brand by Canadian consumers, offering exceptional coverage tailored to protect them and their families. Federally licensed with operations across Canada, Blue Cross Life provides a full suite of top-tier Individual and Group Life and Disability insurance options. This comprehensive range of products is backed by an insurer with decades of experience protecting Canadians. Our employees are the key component in enabling us to deliver competitive life and disability products nationally; we value their knowledge and integrity and are dedicated to their professional development by providing an environment of continuous learning and growth. We seek creative problem solvers who care about the work they do while helping to drive responsiveness and insight throughout our organization. If you are looking for an opportunity in a challenging, fast-paced, and collaborative work environment, the career you have been looking for may be waiting for you at Blue Cross Life. Blue Cross Life Insurance Company of Canada is a federally licensed company that distributes its products through a network of Blue Cross Plans. Blue Cross Life specializes in life insurance, living benefits and disability income protection products to supplement and enhance the portfolio of health and dental products distributed by the Blue Cross Plans. Our employees are the key component in enabling us to deliver competitive life and disability products nationally; we value their knowledge and integrity and are dedicated to their professional development by providing an environment of continuous learning and growth. We seek creative problem solvers who care about the work they do while helping to drive responsiveness and insight throughout our organization. If you are looking for an opportunity in a challenging, fast-paced, and collaborative work environment, the career you have been looking for may be waiting for you at Blue Cross Life. The Opportunity As a Cloud Operations Specialist at Blue Cross Life, you will contribute to the continuous improvement of our cloud infrastructure, automation processes, and evolving DevOps practices. In this role, you will support cloud-based projects, applications, and system integrations while helping improve operational efficiency, scalability, and reliability across the organization. You will work across infrastructure, automation, and operational support activities to help modernize technology practices and strengthen our cloud operations environment. This role offers the opportunity to broaden your cloud and infrastructure experience, deepen your technical expertise, and contribute to the evolution of operational excellence across Blue Cross Life. Your every day with us consists of: - Managing and maintaining cloud services across AWS, M365, data and AI platforms. - Supporting cloud migration initiatives and infrastructure improvement efforts. - Automating routine operational tasks (e.g., instance management, monitoring, reporting) - Supporting cloud-based environments to improve scalability, performance, and reliability. - Contributing to secure and efficient system and network operations. - Supporting the management and optimization of database and data platform technologies. - Collaborating with internal teams, leadership, external service providers, and distributor partners to support operational priorities and continuous improvement. - Creating and maintaining clear technical and operational documentation. - Providing on-call support as required. What you need to succeed: - Knowledge of DevOps best practices, CI/CD pipelines, SDLC, industry trends, and technical solutions. - Strong understanding of technical infrastructure and the software development lifecycle. - Excellent documentation skills. - A proactive, solution-oriented mindset with strong problem-solving capability. - Strong communication and problem-solving skills. - Ability to work independently with minimal supervision in a busy technical environment. - High attention to detail and strong organizational skills. - Strong interpersonal, communication, and sound judgment skills. 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In addition to Base Pay, eligible Medavie employees may participate in various performance-based incentive programs. Payments under these programs are discretionary and subject to both individual and organizational results. #CBM2 This posting is for an existing vacancy within our organization / Ce poste est actuellement vacant au sein de notre organisation. The Base Pay range may vary depending on the successful candidate or other relevant job-related factors such as knowledge, skills, qualifications, experience and education/training. In addition to Base Pay, eligible Blue Cross Life employees may participate in various performance-based incentive programs. Payments under these programs are discretionary and subject to both individual and organizational results. Blue Cross Life is an equal opportunity employer. We strive to foster a culture where everyone is enabled to achieve their full potential - a culture of diversity, equity and inclusion (DEI). Accessibility is a top priority. For applicants with disabilities, we provide accommodations throughout the recruitment, selection and/or assessment process. If selected to participate in the recruitment, selection and/or assessment process, please inform Human Resources staff of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation. Our recruitment process may involve automated tools, including AI, to assist in screening applications. We would like to thank all candidates for expressing interest. Please note that only those selected for interviews will be contacted. If you experience any technical issues throughout the application process, please email: Medavie.Recruitment@medavie.ca. ® Registered trademark of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross Plans and Licensees. Used under license by Blue Cross Life Insurance Company of Canada, an independent licensee of the Canadian Association of Blue Cross Plans.


