<span>Claims Examiner - Remote (HealthRules required)</span>

NTT DATA • Dallas, TX

381d • $37,440 - $49,920 • Remote

About The Position

The Claims Examiner position at NTT DATA involves processing medical claims, ensuring compliance with regulations, and maintaining high-quality standards. The role requires independent work to review and adjudicate claims while adhering to defined workflows and timelines.

Requirements

• 2+ years of experience in medical claims processing
• 1+ year of experience processing claims with HealthRules or Visual Basic
• High school diploma or GED

Responsibilities

• Processing of Professional claim forms files by provider
• Reviewing the policies and benefits
• Complying with company regulations regarding HIPAA, confidentiality, and PHI
• Abiding with the timelines to complete compliance training of NTT Data/Client
• Working independently to research, review and act on the claims
• Prioritizing work and adjudicating claims as per turnaround time/SLAs
• Ensuring 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 calculating claims payable amount using applicable methodology

Benefits

• Remote work opportunity
• Competitive hourly wage of $18 - $24
• Diverse and inclusive work environment
• Opportunities for professional development

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees