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, and correctly calculating claims payable amount using applicable methodology / fee schedule. Requirements include 3 years 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, and working knowledge of MS office products Outlook, MS Word and MS-Excel. Preferred skills and experiences include 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, and time management with the ability to cope in a complex, changing environment.