[Hiring] Medical Claims Examiner @NTT DATA Services

Role Description

• 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, Claims Adjustments
• 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 – toggling back and forth between screens
• Working knowledge of MS office products – Outlook, MS Word and MS-Excel
• Must be able to work 8 am - 4:30 pm EST online/remote (training is required on-camera)
• 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
• Ability to communicate (oral/written) effectively in a professional office setting
• High School Diploma

Requirements

• Amisys or Xcelys preferred