Medical Claims Examiner

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team.

In this Role the candidate will be responsible for:

•           Processing of Professional 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:

•           3 year(s) hands-on experience in Healthcare Claims Processing

•           2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools

•           High school diploma or GED.

•           Previously performing – in P&Q work environment; work from queue; remotely

•           Key board skills and computer familiarity –

o          Toggling back and forth between screens/can you navigate multiple systems.

o          Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences:

•           Amisys

•           Ability to communicate (oral/written) effectively in a professional office setting

•           Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities

•           Time management with the ability to cope in a complex, changing environment