Medical Claims Tester

NTT DATA North America; Merced (CA); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking a Medical Claims Tester to enhance the claims processing system. The ideal candidate will have extensive experience in Medicare claims and a strong understanding of CMS guidelines. The role involves gathering requirements and facilitating testing to ensure compliance and efficiency.

Benefits

Medical, dental, and vision insurance

401k program with company match

Paid time off

Flexible spending account

Qualifications

• 5+ years of Medicare claims testing.
• 1+ years of D-SNP experience.
• Familiarity with system migrations.

Responsibilities

• Lead business requirements sessions for D-SNP claims.
• Oversee UAT planning and defect resolution.
• Develop test plans for D-SNP claims processing.

Skills

Detail-oriented

Claims processing

CMS compliance

Education

High School Diploma or GED

Tools

Claims processing platforms

Agile development methodologies

Job description

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy

NTT DATA currently seeks a Medical Claims Tester to join our team in remote in the US.

Job Overview

We are seeking a detail-oriented and experienced Medical Claims Tester with specialized knowledge in Medicare and D-SNP claims processing. The ideal candidate will bring a strong understanding of CMS guidelines, particularly related to the implementation of claims solutions within the California D-SNP market. This role plays a critical function in bridging requirements gathering, user acceptance testing (UAT), and overall claims system validation to ensure a seamless and compliant platform experience.

Key Responsibilities

• Lead and facilitate business requirements sessions related to D-SNP claims processes and CMS compliance.
• Draft, manage, and validate end-to-end business requirements to support the implementation of claims system enhancements.
• Oversee UAT planning, execution, and defect resolution in coordination with QA, business, and IT stakeholders.
• Develop and maintain test plans with a focus on D-SNP-related claims processing scenarios.
• Assess downstream implications of changes across the claims platform, ensuring regulatory and functional alignment.
• Collaborate with cross-functional teams including product owners, developers, and system administrators.
  
  

Required Qualifications

• 5+ years pf proven experience with Medicare claims testing, including a deep understanding of CMS requirements and regulatory guidance.
• 1+ years of D-SNP experience
• High School Diploma or GED
  
  

Preferred Qualifications

• Exposure to modernized claims processing platforms and agile development methodologies.
• Hands-on experience with claims system migrations, especially transitions off HSP/Conduent platforms.
• Familiarity with Conduent HSP core claims system (or similar legacy platforms).
  
  

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 starting hourly range for this remote role is ($78.50- $90.50/hourly ). 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 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.