Claims processing

NTT DATA•Plano, TX

About The Position

In these roles you will be responsible for: Review and process insurance claims. Validate Member, Provider and other Claim's information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines University degree or equivalent that required formal studies of the English language and basic Math 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product. 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 6+ months of experience that required prioritizing your workload to meet deadlines Ability to communicate (oral/written) effectively to exchange information with our client. Commerce graduate with English as a compulsory subject 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills

Requirements

University degree or equivalent that required formal studies of the English language and basic Math
6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions
6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
6+ months of experience that required prioritizing your workload to meet deadlines
Ability to communicate (oral/written) effectively to exchange information with our client.
Commerce graduate with English as a compulsory subject
1-3 years of experience in processing claims adjudication and adjustment process
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills

Nice To Haves

Experience of Facets is an added advantage.
Experience in professional (HCFA), institutional (UB) claims (optional)

Responsibilities

Review and process insurance claims
Validate Member, Provider and other Claim's information
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure
Coordination of Claim Benefits based on the Policy & Procedure
Maintain productivity goals, quality standards and aging timeframes
Scrutinizing Medical Claim Documents and settlements
Organizing and completing tasks per assigned priorities
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Process Adjudication claims and resolve for payment and Denials
Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
Organizing and completing tasks according to assigned priorities
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines