Claims Examiner Remote

NTT DATA, Inc.; Plano (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

NTT DATA, Inc. is seeking a Remote Claims Processing Associate to support our end client’s team. The candidate will process professional claim forms, review policies and benefits, and ensure HIPAA and PHI compliance while meeting client SLAs.

The role requires 3 years of healthcare claims processing experience, strong MS Office skills, and the ability to work remotely with multi-system navigation. Prior remote work experience is preferred.

Qualifications

• 3 years hands-on experience in Healthcare Claims Processing.
• 2+ years using a computer with Windows applications and navigating multiple screens.
• High school diploma or GED.
• Remote work experience in a P&Q environment; work from queue; remotely.

Responsibilities

• Processing of Professional claim forms files by provider.
• Reviewing the policies and benefits.
• Comply with HIPAA, confidentiality, and PHI.
• Abide with the timelines to complete compliance training.
• Work independently to research, review and act on the claims.
• Prioritize work and adjudicate claims per turnaround time/ SLAs.
• Ensure claims are adjudicated per client workflows and guidelines.
• Maintain quality scores above 98.5% PA and 99.75% FA.
• Timely responses and resolution of claims received via emails.

Skills

Healthcare Claims Processing

Windows applications

MS Office

Education

High school diploma or GED

Tools

Outlook

MS Word

MS Excel

Amisys

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 –
• 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