Medical Claims Processor

Lensa; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

Lensa, in partnership with NTT DATA, is seeking a Medical Claims Processor to work remotely. The role involves processing claims, ensuring compliance with HIPAA regulations, and achieving client quality targets. Ideal candidates will have a background in medical claims processing and strong skills in computer applications.

Benefits

Medical, dental, and vision insurance

Flexible spending or health savings account

Long-term disability coverage

Paid time off

401k program with company match

Qualifications

• Minimum of 2 years of Medical Claims experience.
• Experience with Claims Adjudication Systems is a plus.
• High School diploma or equivalent is required.

Responsibilities

• Process Professional and Hospital claim forms filed by providers.
• Review policies and benefits to ensure compliance.
• Work independently to research and adjudicate claims.

Skills

Medical Claims experience

Windows applications navigation

Claims Adjudication Systems

Education

High School diploma or equivalent

Job description

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Job Title

Medical Claims Processor

Industry

Healthcare

FSLA status

Non-Exempt

Department

Operations

Level

Entry to mid-level

Location

Work at Home

Pay Rate

$17.00-18.00

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 Medical Claims experience
• 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
• 1+ years of working with Claims Adjudication Systems
• High School diploma or equivalent

Preference

• 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

Where required by law, 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.

This position is eligible for company benefits that will depend on the nature of the role offered. 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.

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If you have questions about this posting, please contact [e-mail]

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• IT Services and IT Consulting

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