Remote Medical Claims Representative

NTT DATA•Plano, TX

3d•Remote

About The Position

NTT DATA is seeking a Remote Medical Claims Representative to join their team. This is a US-based, W-2 project where all candidates will be paid through NTT DATA. The role involves processing professional claim forms, reviewing policies and benefits, and ensuring compliance with HIPAA, confidentiality, and PHI regulations. The representative will work independently to research, review, and act on claims, prioritizing work and adjudicating claims according to turnaround times and SLAs. Adherence to client-defined workflows and guidelines is crucial, as is meeting client productivity and quality targets to avoid penalties. Maintaining high quality scores (above 98.5% PA and 99.75% FA) and timely response to claims received via email are key responsibilities. The role requires calculating claims payable amounts accurately, effective troubleshooting, and strong time management skills in a complex and changing environment. Effective oral and written communication in a professional office setting is also necessary.

Requirements

1+ year(s) hands-on experience in Healthcare Claims Processing
Previously performing – in P&Q work environment; work from queue; remotely
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
Key board skills and computer familiarity – Toggling back and forth between screens /can you navigate multiple systems.
Working knowledge of MS office products – Outlook, MS Word and MS-Excel

Nice To Haves

Amisys &/or Xcelys

Responsibilities

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
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