Medical Claims Examiner

JOB DESCRIPTION

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 claim forms files by provider

• Reviewing the policies and benefits

• Comply with company regulations regarding HIPAA, confidentiality, and PHI

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

• Work independently to research, review and act on the claims

• Prioritize work and adjudicate claims as per turnaround time/SLAs

• Ensure 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 calculate claims payable amount using applicable methodology/ fee schedule

Requirements:

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

• 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools

• High school diploma or GED.

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

• Key board skills and computer familiarity –

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

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

Preferred Skills & Experiences:

• Amisys

• 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