Medical Claims Examiner Remote

NTT America, Inc.; Plano (TX); Remote; USD 36,000 - 48,000; Full time

Job summary

NTT DATA seeks a Medical Claims Examiner to join our team in Plano, Texas. This role focuses on reviewing and processing insurance claims, validating information, and determining payment criteria in alignment with policy and procedures.

As a Remote position, you will coordinate benefits, maintain productivity, and resolve complex situations while building expertise in healthcare insurance processes. Strong data entry, attention to detail, and English proficiency are essential.

Qualifications

• University degree or equivalent required; formal studies of English language and basic math.
• 6+ months of experience applying business rules to varying fact situations.
• 6+ months of data entry with focus on quality, accuracy and accountability.

Responsibilities

• Review and process insurance claims.
• Validate Member, Provider and other Claim information.
• Determine accurate payment criteria for clearing pending claims based on policy and procedure.
• Coordinate of Claim Benefits based on Policy & Procedure.
• Maintain productivity goals, quality standards and aging timeframes.
• Scrutinizing Medical Claim Documents and settlements.
• Organize and complete tasks per assigned priorities.
• Develop and maintain knowledge of healthcare insurance industry and products/services.
• Resolve complex situations following established guidelines.

Skills

Data entry

Attention to detail

Time management

Communication skills

English proficiency

Education

University degree or equivalent

Tools

Windows PC

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 Medical Claims Examiner Remote to join our team in Plano, Texas (US-TX), United States (US).

In these roles you will be responsible for:

• Review and process insurance claims.
• Validate Member, Provider and other Claim’s information.
• Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
• Coordination of Claim Benefits based on the Policy & Procedure.
• Maintain productivity goals, quality standards and aging timeframes.
• Scrutinizing Medical Claim Documents and settlements.
• Organizing and completing tasks per assigned priorities.
• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
• Resolving complex situations following pre-established guidelines

Requirements for this role include:

• University degree or equivalent that required formal studies of the English language and basic Math
• 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions
• 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
• 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
• 6+ months of experience that required prioritizing your workload to meet deadlines

Preferences:

• Ability to communicate (oral/written) effectively to exchange information with our client.
• Commerce graduate with English as a compulsory subject

Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.

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 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 (http://us.nttdata.com/en/compliance#eeos). If you'd like more information on your EEO rights under the law, please click here (http://us.nttdata.com/en/compliance#know-your-rights). For Pay Transparency information, please click here (http://us.nttdata.com/en/compliance#ppnp).