Medical Claims Processor

NTT DATA North America; Missouri; Remote; USD 23,419 - 24,796; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401k program with company match

Paid time off

Job summary

A national healthcare services provider is looking for a Medical Claims Processor to work remotely. Responsibilities include processing claims, reviewing policies, and ensuring compliance with regulations. Ideal candidates will have at least 2 years of medical claims experience and the ability to work independently. The role offers competitive hourly compensation ranging from $17.00 to $18.00, alongside benefits including health insurance and retirement plans.

Qualifications

• 2+ years of Medical Claims experience.
• 2+ years using a computer with Windows applications.
• 1+ years working with Claims Adjudication Systems.

Responsibilities

• Process Professional and Hospital claim forms.
• Review policies and benefits.
• Comply with HIPAA and confidentiality regulations.
• Work independently on claims.
• Meet productivity and quality targets.

Skills

Medical Claims experience

Using computer with Windows applications

Claims Adjudication Systems

Effective communication

Troubleshooting skills

Time management

Education

High School diploma or equivalent

Job description

Pay Rate: $17.00-18.00

Job Title: Medical Claims Processor
Industry: Healthcare
FSLA status: Non-Exempt
Department: Operations
Level: Entry to mid-level
Location: Work at Home

Responsibilities

• 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

Requirements

• 2+ year(s) of Medical Claims experience
• 2+ year(s) using a computer with Windows applications that required you to use a keyboard, navigate multiple screens and computer systems, and learn new software tools
• 1+ years of working with Claims Adjudication Systems
• High School diploma or equivalent

Preferences

• Ability to communicate (oral/written) effectively in a professional office setting
• Effective troubleshooting skills where you can leverage your research, analysis and problem-solving skills
• Time management skills that require the ability to cope with a complex, changing environment

NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $17.00-18.00. This range reflects the minimum and maximum 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.

This position may also be eligible for incentive compensation based on individual and/or company performance. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.