Claims Examiner

Remote Claims Processing Associate

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 and institutional claims

Reviewing the policies and benefits

Complying with company regulations regarding HIPAA, confidentiality, and PHI

Abiding with the timelines to complete compliance training of NTT Data / Client

Working independently to research, review, and act on the claims

Prioritizing work and adjudicating claims as per turnaround time / SLAs

Ensuring 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 calculating claims payable amount using applicable methodology / fee schedule

Requirements :

3 year(s) hands-on experience in Healthcare Claims Processing

High school diploma or GED.

Previously performing in P&Q work environment; work from queue; remotely

Key board skills and computer familiarity

Toggling back and forth between screens / can you navigate multiple systems.

Working knowledge of MS office products Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences :

Amisys or Xcelys

Medicaid and Medicare Claims processing experience

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