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Claims Examiner

Claims Examiner

NTT DATAOxnard, CA, US
1 day ago
Job type
  • Full-time
Job description

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 the client's 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
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    Examiner • Oxnard, CA, US

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