HC & Insurance Operations Processing Sr Rep

NTT DATA, Inc.; Plano (TX); Remote; USD 42,000 - 54,000; Full time

Job summary

NTT DATA, Inc. is seeking a Remote Claims Processing Associate to support our end client’s team. The role focuses on processing professional claims, reviewing policies and benefits, and upholding HIPAA and PHI confidentiality.

You will work remotely, navigate multiple systems, and ensure timely adjudication in line with client workflows and SLAs, while maintaining high quality scores and productivity.

Qualifications

• 3 years hands-on experience in Healthcare Claims Processing.
• 2+ years using Windows applications and navigating multiple screens/systems.
• High school diploma or GED required.

Responsibilities

• Process Professional claim forms by provider according to policies and workflows.
• Review policies and benefits and verify accuracy of claim details.
• Ensure HIPAA compliance and confidentiality of PHI.

Skills

Healthcare claims processing

Keyboard & multi-screen navigation

MS Office proficiency

Education

High school diploma or GED

Tools

MS Outlook

MS Word

MS Excel

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