Claims Examiner Remote

NTT DATA Services•Plano, TX

10d•Remote

About The Position

NTT DATA is seeking a Remote Claims Processing Associate to work for an end client and its team. The role processes professional provider claim files, reviews policies and benefits, and independently researches, reviews, and acts on claims. The Claims Examiner prioritizes work and adjudicates claims according to client workflows, guidelines, turnaround times, and service-level agreements. The role is also responsible for meeting client productivity and quality targets, maintaining specified quality scores, responding promptly to claims received by email, and accurately calculating payable amounts using applicable methodologies and fee schedules. The position requires compliance with HIPAA, confidentiality, and protected health information requirements, as well as timely completion of NTT DATA and client compliance training.

Requirements

Three years of hands-on experience in healthcare claims processing.
At least two years of experience using a computer with Windows applications, including keyboard use, navigating multiple screens and computer systems, and learning new software tools.
High school diploma or GED.
Previous experience in a productivity and quality (P&Q) work environment, working from a queue, and working remotely.
Keyboard skills and computer familiarity, including toggling between screens and navigating multiple systems.
Working knowledge of Microsoft Office products, including Outlook, Word, and Excel.

Nice To Haves

Experience with Amisys.
Ability to communicate effectively, orally and in writing, in a professional office setting.
Effective troubleshooting skills using research, analysis, and problem-solving abilities.
Time-management skills and the ability to cope in a complex, changing environment.

Responsibilities

Process professional claim form files submitted by providers.
Review policies and benefits.
Comply with company regulations regarding HIPAA, confidentiality, and protected health information (PHI).
Complete NTT DATA and client compliance training within required timelines.
Independently research, review, and act on claims.
Prioritize work and adjudicate claims within turnaround times and service-level agreements (SLAs).
Adjudicate claims according to client-defined workflows and guidelines.
Meet client productivity and quality targets to avoid penalties.
Maintain quality scores above 98.5% PA and 99.75% FA.
Respond to and resolve claims received via email promptly, treating them as priority work.
Calculate claim payable amounts accurately using applicable methodologies and fee schedules.