Claims Examiner Remote
About The Position
NTT DATA is seeking a remote Claims Examiner to process professional healthcare claims for its end client. The role involves reviewing policies and benefits, researching and adjudicating claims independently, and ensuring claims are handled according to client workflows, guidelines, turnaround times, and service-level agreements. The examiner calculates payable amounts using the applicable methodology or fee schedule and responds to claims received by email as priority work. The position requires compliance with company regulations concerning HIPAA, confidentiality, and protected health information, as well as timely completion of NTT DATA and client compliance training. The employee is expected to meet client productivity and quality targets, maintaining quality scores above 98.5% PA and 99.75% FA.
Requirements
- At least 3 years of hands-on healthcare claims processing experience.
- At least 2 years of experience using a computer with Windows applications, navigating multiple screens and systems, and learning new software tools.
- High school diploma or GED.
- Prior experience in a productivity-and-quality 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 Outlook, Word, and Excel.
Nice To Haves
- Experience with Amisys.
- Ability to communicate effectively, orally and in writing, in a professional office setting.
- Troubleshooting skills that leverage research, analysis, and problem-solving abilities.
- Time-management skills and the ability to cope in a complex, changing environment.
Responsibilities
- Process professional claim forms filed by providers.
- Review policies and benefits.
- Comply with HIPAA, confidentiality, and PHI requirements.
- Complete NTT DATA and client compliance training within required timelines.
- Independently research, review, and act on claims.
- Prioritize work and adjudicate claims according to turnaround times and SLAs.
- Adjudicate claims according to client-defined workflows and guidelines.
- Meet client productivity and quality targets.
- Maintain quality scores above 98.5% PA and 99.75% FA.
- Respond to and resolve claims received via email in a timely manner, prioritizing them as required.
- Calculate payable claim amounts using the applicable methodology or fee schedule.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
