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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.

For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

NTT DATA currently seeks a Utilization Management Coordinator to join our team for a remote position.

100% Remote, Client provides equipment

Temporary Role – Duration 6 months with possibility of extension and direct hire

Pay Rate $22-$23/hr

Position Summary:

The Utilization Management Coordinator reports to the Director of Claims. This position is responsible for coordinating the appeal activities and UM process which includes initiating Case Management, requesting Pre-Certification, submitting Medical Reviews, and Independent Dispute Resolution. The successful candidate(s) will bring the utmost level of service, professionalism, and commitment to this position.

Responsibilities:

+ Gather, analyze, and report information regarding member and provider appeals.

+ Prepare and respond to written inquiries from employers, members, and providers in accordance with Department of Labor guidelines and applicable summary plan document language.

+ Maintain files and logs for all appeals.

+ Interface with various managed care organizations, UM, and cost containment Vendors to coordinate reviews for medical necessity including pre-determinations and retrospective reviews.

+ Review submissions by the Claims Department to determine appropriateness of services through established UM guidelines, Trilogy, summary plan document review, etc.

+ Actively participate in meetings including presentation of reports, statistics, etc.

+ Perform other related duties and participate in special projects as assigned.

Knowledge, Skills and Abilities:

+ Strong administrative/technical skills; Comfortable working on a PC using Microsoft Office, Microsoft Teams, and telephones efficiently.

+ Excellent communication skills (spoken and written); comfortable talking on the phone for extended periods of time and replying to emails in a timely manner.

+ Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily.

+ Willingness to routinely, reliably come to work on schedule and adjust shift/scheduling based on the needs of the organization (including occasional paid overtime)

+ Education: High School Diploma or General Education Development (GED) equivalent.

About NTT DATA:

NTT DATA is a $30+ billion trusted global innovators of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com.

NTT DATA 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 accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is ($22-$23/hourly). This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include 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.