Claims Examiner Remote

NTT DATA Group; Plano (TX); Remote; USD 55,000 - 70,000; Full time

Job summary

NTT DATA, Inc. is seeking a Remote Claims Processing Associate to support its client’s claims operations from Plano, Texas.

The role involves processing professional claim forms, reviewing policies and benefits, and ensuring HIPAA/PHI confidentiality while adhering to client workflows and turnaround times. Ideal candidates will have 3+ years of healthcare claims processing experience, strong MS Office skills, and the ability to work remotely with excellent time management and research abilities.

Qualifications

• 3 years hands-on experience in Healthcare Claims Processing.
• 2+ years using Windows applications and learning new software tools.
• High school diploma or GED.

Responsibilities

• Process professional claim forms by provider and adjudicate per workflows.
• Review policies and benefits and ensure HIPAA/PHI compliance.
• Meet turnaround time/SLAs and maintain high quality scores (above 98.5% PA and 99.75% FA).
• Respond to claims via email promptly and resolve issues using established fee schedules.

Skills

Time management

Troubleshooting

Communication skills

Multitasking

Education

High school diploma or GED

Tools

Amisys

MS Office (Outlook, Word, Excel)

Job description

We are currently seeking a Claims Examiner Remote to join our team in Plano, Texas (US-TX), United States (US).

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team.

• 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 –
• 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
• 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

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.

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 .

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