Claims Examiner

Req ID: 349306 

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, apply now.

We are currently seeking a Claims Examiner to join our team in Plano, Texas (US-TX), United States (US).

Position's General Duties and Tasks

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:  - Optional (nice-to-have’s)

• 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.

Roles and Responsibilities:

• Process Adjudication claims and resolve for payment and Denials

• Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
• Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations

• Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
• Organizing and completing tasks according to 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:

• 1-3 years of experience in processing claims adjudication and adjustment process
• Experience of Facets is an added advantage.
• Experience in professional (HCFA), institutional (UB) claims (optional)
• Both under graduates and post graduates can apply
• Good communication (Demonstrate strong reading comprehension and writing skills)
• Able to work independently, strong analytic skills

**Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). 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 recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.

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