Claims Examiner Remote

NTT DATA, Inc.; Plano (TX); Hybrid; USD 42,000 - 64,000; Full time

Job summary

NTT DATA is seeking a Remote Claims Processing Associate to join the Plano, Texas team. In this role you will handle professional claims, review policies and benefits, and ensure compliance with HIPAA and PHI.

The position emphasizes independent adjudication of claims, adherence to SLAs, and accurate calculation of payable amounts. Candidates should have 3 years of healthcare claims processing experience and strong MS Office skills.

Qualifications

• 3 years of hands-on experience in healthcare claims processing.
• Proficient with MS Office and multiple software tools.
• Strong communication and problem-solving skills.
• Ability to work remotely with minimal supervision.

Responsibilities

• Process professional claim forms by provider.
• Review policies and benefits.
• Ensure HIPAA, confidentiality and PHI compliance.
• Adhere to training and client SLAs.
• Research, review and adjudicate claims independently.
• Prioritize work to meet turnaround times.
• Ensure adherence to client workflows and guidelines.
• Maintain quality scores above targets.
• Respond to emails promptly with claim resolutions.
• Calculate payable amounts using applicable schedules.

Skills

Healthcare claims processing

Communication

Time management

Research & analysis

Problem solving

Education

High school diploma or GED

Tools

MS Office

Amisys

Job description

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization,

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.

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

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.

Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees.

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.

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