Healthcare Insurance Representative - Hybrid

Healthcare Coverage Determination Representative

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. NTT DATA Services currently seeks a Healthcare Coverage Determination Representative to join our team for a HYBRID role in San Antonio TX. 2-3 days in office, 2 days remote Hours: Training 9am-5pm EST (approx 8 weeks). After training hours: 8am-8pm (assigned 8 hour shift) with a possible weekend rotation. Pay rate: $18.97 per hour Project duration: 1 year, with start date of 11/16/2026 Will be required to be on camera during training and other meetings, as required by supervisor The Customer Service/Coverage Determination/Appeals Service Representative is responsible for working and triaging in the data entry related fax queues. The Representative's primary responsibilities will be to review each document with accuracy and place the case in the proper queues. Further responsibilities include researching reports, maintaining complete, timely and accurate documentation of Coverage Determination/Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed.

Responsibilities

• Review Fax documents appropriately and forward to appropriate queues
• Update and maintain knowledge of relevant process, regulation and clinical material.
• Provide assistance or guidance in partnership with learning and innovation when needed
• Participate in developmental discussions receiving feedback with Supervisor

Required Experience:

• 1+ years experience in the medical insurance field
• 1+ year experience using MS Office on a daily basis

Education: Verifiable High School Diploma or GED Required NTT DATA provides a reasonable range of compensation for U.S.-based positions. The starting pay range for this role is $18.97 per hour. Actual compensation will depend on a number of factors, including the candidate's relevant experience, technical skills, and other qualifications. NTT DATA Services is an equal opportunity employer and considers all applicants without regarding 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. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.