[Hiring] HC & Insurance Operations Processing Sr Rep @NTT DATA Services

Role Description

NTT DATA currently seeks a Claims Processor to join our team for a remote position.

• 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

Qualifications

• 1-3 year(s) hands-on experience in Healthcare Claims Processing
• 2+ year(s) using a computer with Windows applications
• High school diploma or GED
• Previously performing in P&Q work environment; work from queue; remotely
• Key board skills and computer familiarity
• Working knowledge of MS office products – Outlook, MS Word, and MS-Excel
• Must be able to work 8 am - 4 pm EST online/remote (training is required on-camera)
• Effective troubleshooting skills
• Time management with the ability to cope in a complex, changing environment
• Ability to communicate (oral/written) effectively in a professional office setting

Requirements

• University degree or equivalent that required formal studies of the English language and basic Math
• 6+ months of experience applying business rules to varying fact situations
• 6+ months of data entry experience focusing on quality, attention to detail, accuracy, and accountability
• 6+ months of experience using a computer with Windows PC applications
• 6+ months of experience prioritizing workload to meet deadlines

Preferences

• Ability to communicate (oral/written) effectively to exchange information with our client
• Commerce graduate with English as a compulsory subject

Benefits

• 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
• Additional voluntary or legally required benefits