Medical Claims Examiner - Remote U.S.

Lensa; Dallas (TX); Remote; USD 60,000 - 80,000; Part time

Job summary

Join a dynamic and innovative team as a Remote Claims Examiner, where you'll play a crucial role in processing healthcare claims and ensuring compliance with industry standards. This position offers the opportunity to work independently while meeting productivity and quality targets. You will be part of a global leader in business and technology services, committed to fostering a diverse and inclusive environment. If you are detail-oriented and passionate about the healthcare industry, this role is perfect for you. Embrace the chance to contribute to meaningful work that impacts lives positively while enjoying the flexibility of remote work.

Qualifications

• 2 years of full cycle healthcare claims processing experience required.
• Proficient in using Windows applications and navigating multiple systems.

Responsibilities

• Process professional and hospital claim forms by provider.
• Ensure compliance with HIPAA and company regulations.

Skills

Healthcare claims processing

Windows applications

Effective communication

Navigating multiple systems

Education

High school diploma or GED

Tools

MS Office (Outlook, Word, Excel)

Job description

Lensa is the leading career site for job seekers at every stage of their career. Our client, NTT DATA North America, is seeking professionals. Apply via Lensa today!

NTT DATA is currently seeking 50 Remote Claims Examiners to join our team.

(Amisys or Xcelys experience is a plus)

• Must be able to work Monday to Friday 7 AM to 4 PM Central time.

In This Role The Candidate Will Be Responsible For

• Processing of Professional and Hospital 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.

Required Skills For This Role Include

• 2 years of healthcare claims processing (full cycle: Pay, Pend, Deny)
• 2 years using a computer with Windows applications that required you to use a keyboard, navigate multiple screens and computer systems, and learn new software tools
• High school diploma or GED.

Preference

• Experience processing claims in Amisys or Xcelys is a plus.
• Ability to communicate (oral/written) effectively in a professional office setting
• Familiar with toggling back and forth between screens/can you navigate multiple systems.
• Working knowledge of MS office products like – Outlook, MS word and MS-excel.

About NTT DATA

NTT DATA is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com.

NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The hourly rate for this remote role is $18 hourly. This rate reflects the target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.

Seniority level

• Entry level

Employment type

• Part-time

Job function

• Finance and Sales
• Industries
• IT Services and IT Consulting