Manila, Metro Manila, Philippines · Hybrid
Req ID: 379945 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Medical records, Utilization management, Appeals processing, Clinical reviews, NCQA standards
Gurgaon, Haryana, India · On-site
About NTT DATA: With people at the heart of our success, NTT DATA is committed to attracting and growing the best talent and providing an environment where everyone feels they can belong and their contribution matters. I…
Skills: Communication, Sales mindset, Persuasive ability, Active listening, Customer empathy
Manila, Metro Manila, Philippines · On-site
Req ID: 380967 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Customer service, Technical support, Communication skills, Time management, Organizational skills
Jersey City, New Jersey, United States · Hybrid
$105k–$182k/yr
Req ID: 382110 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Prompt engineering, LLM interaction design, Prompt optimization, GenAI application quality, RAG systems
Karnataka, India · On-site
Key responsibilities Design and build AI-enabled applications for DB Intelligence, including user-facing workflows, APIs, microservices, orchestration components and data integration layers. Build Python services for AI/…
Skills: Python, AI/ML, LLM APIs, RAG, FastAPI
Bengaluru, Karnataka, India · Hybrid
Req ID: 378784 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Windows System Administration, Hardware Maintenance, Software Installation, Troubleshooting, Network Support
Pune, Maharashtra, India · Hybrid
Req ID: 354983 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: AWS, Kubernetes, Terraform, GitHub Actions, CI/CD
Mexico · Remote OK
Req ID: 378330 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Incident Response, Access Management, Security Auditing, Triaging Security Alerts, Root Cause Analysis
Nashville, Tennessee, United States · On-site
$88k–$132k/yr
Req ID: 379105 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Collibra, Data Governance, Data Cataloging, Metadata Management, Data Lineage
Noida, Uttar Pradesh, India · Hybrid
Req ID: 372397 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Incident Management, Problem Management, L2/L3 Support, Healthcare Provider Domain, Hospital Workflows
Plano, Texas, United States · On-site
$135k–$247k/yr
Req ID: 378574 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Databricks, Apache Spark, Delta Lake, Unity Catalog, Python
Plano, Texas, United States · On-site
$135k–$247k/yr
Req ID: 378574 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Databricks, Apache Spark, Delta Lake, Unity Catalog, AWS
Bangalore, Karnataka, India · Remote OK
Application Services Modernization Advisory Director – REMOTE Join NTT DATA Americas Application Services and help shape the future of enterprise modernization! Who We Are NTT DATA Americas Application Services group is …
Skills: Enterprise Architecture, Application Modernization, Cloud Migration, Generative AI, Agentic AI
Bangalore, Karnataka, India · On-site
Req ID: 369149 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: IT Service Desk Support, Troubleshooting, Customer Service, English Communication, Windows 10
Bethesda, Ohio, United States · Remote OK
$96k–$178k/yr
Req ID: 375962 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: IoT Architecture, Edge Computing, AWS GovCloud, AWS IoT Device Management, AWS Greengrass
Noida, Uttar Pradesh, India · Hybrid
Req ID: 372397 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Healthcare Provider Domain, Incident Management, Problem Management, L2/L3 Support, Root Cause Analysis
Nashville, Tennessee, United States · On-site
$88k–$134k/yr
Req ID: 379105 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Collibra, Data governance, Data catalog, Business glossaries, Stewardship models
Mexico City, Mexico · On-site
Req ID: 377728 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Hardware Integration, Software Installation, Networking, Troubleshooting, Desktop Support
Guadalajara, Castile-La Mancha, Spain · On-site
Req ID: 378755 NTT DATA Services strives to hire exceptional, innovative, and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply n…
Skills: L1 Technical Support, Hardware Troubleshooting, MS Office, Incident Documentation, Diagnostic Techniques
Plano, Texas, United States · Remote OK
$201k–$372k/yr
Req ID: 379238 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are…
Skills: Product Strategy, AI Product Management, Banking Domain Expertise, GenAI, Agentic Workflows
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The specialist prepares and researches medical case reviews for directors while ensuring compliance with State, Federal, and NCQA standards. They also communicate with providers and interdepartmental teams to improve clinical appeals processes and maintain accurate documentation.
Candidates must be a Registered Nurse (RN) with 1-3 years of experience in appeals or utilization management and 1 year in an advanced role. Strong analytical skills, knowledge of Medicaid regulations, and excellent communication abilities are required.
Req ID: 379945
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
We are currently seeking a BPO Medical Records Specialist to join our team in Manila, Quezon (PH-QUE), Philippines (PH).
"Roles and Responsibilities:
• Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal.
• Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal.
• Ensures timely review, accurate processing, and response to appeal in accordance with State, Federal and NCQA standards.
• May also perform clinical reviews. Review claim appeal for reconsideration and recommend approvals/denials based on determination level or prepare for medical review presentation.
• Communicates with providers, facilities and other departments regarding appeal requests.
• Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal an d NCQA standards.
• Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeal requests.
• Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices.
• Individuals have a well-rounded knowledge of the policies and procedures for appeals processing, specifically for Medicaid and medical necessity review.
• Uses sound judgement, especially in non-routine appeals, to make decisions to keep the appeal process moving forward in accordance with contractual timeliness standards.
• Maintain files on individual appeals by gathering, analyzing and reporting verbal and written member and provider appeals.
• 1-3 years of experience in processing appeals or utilization management.
• 1 yr experience in advanced roles such as team lead, trainer, SME, or QA
• RN - Registered Nurse - State required Licensure and/or Compact State Licensure
• Knowledge of utilization management process
• Knowledge of NCQA, Medicaid requlations
• Good communication (Demonstrate strong reading comprehension and writing skills)
• Able to work independently, strong analytic skills
• Required shift timings - US daytime"
About NTT DATA
NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.
Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.
NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.
NTT DATA, Inc. is a trusted global innovator of business and technology services. We're committed to helping clients innovate, optimize and transform for long-term success. Our R&D investments help organizations and society move confidently and sustainably into the digital future. As a 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.
Offices: 7950 Legacy Drive, Suite 900, Plano, Texas 75024, US · 18 S End Road, Bengaluru, Karnataka 560004, IN
NTT DATA, Inc. is a trusted global innovator of business and technology services. We're committed to helping clients innovate, optimize and transform for long-term success. Our R&D investments help organizations and society move confidently and sustainably into the digital future. As a 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.
Offices: 7950 Legacy Drive, Suite 900, Plano, Texas 75024, US · 18 S End Road, Bengaluru, Karnataka 560004, IN
