HC & Insurance Operations Processing Sr Rep

NTT DATA Services•Plano, TX

4d•Remote

About The Position

NTT DATA is seeking a Remote Claims Processing Associate to work for its end client and team. The role processes and adjudicates professional claims, reviews policies and benefits, researches claims independently, and ensures work follows client workflows, guidelines, turnaround times, and service-level agreements. The associate is expected to meet client productivity and quality targets, maintain specified quality scores, respond to claims received by email as priority work, and accurately calculate payable amounts using the applicable methodology or fee schedule. The role also requires compliance with company regulations concerning HIPAA, confidentiality, and protected health information, as well as completing NTT DATA and client compliance training within required timelines.

Requirements

At least 3 years of hands-on experience in healthcare claims processing.
At least 2 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, including research, analysis, and problem-solving abilities.
Time-management skills and the ability to cope in a complex, changing environment.

Responsibilities

Process professional claim forms 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.
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 in a timely manner, treating them as priority work.
Calculate claim payable amounts correctly using the applicable methodology or fee schedule.