Healthcare Claims Processor, Remote

Role Overview

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client. In this role, the candidate will be responsible for:

• Processing of professional claim forms files by provider.
• Reviewing policies and benefits.
• Complying with company regulations regarding HIPAA, confidentiality, and PHI.
• Abiding by timelines to complete compliance training.
• Working independently to research, review, and act on claims.
• Prioritizing work and adjudicating claims as per turnaround time/SLAs.
• Ensuring claims are adjudicated as per client-defined workflows and guidelines.
• Sustaining and meeting client productivity/quality targets.
• Maintaining quality scores above 98.5% PA and 99.75% FA.
• Providing timely response and resolution of claims received via email.
• Correctly calculating claims payable amounts using applicable methodology/fee schedules.

• 1-3 years of hands-on experience in Healthcare Claims Processing.
• 2+ years of experience using Windows applications, navigating multiple screens, and learning new software tools.
• High school diploma or GED.
• Previous experience in a P&Q work environment, working from a queue, and working remotely.
• Strong keyboard skills and computer familiarity.
• Ability to toggle between screens and navigate multiple systems.
• Working knowledge of MS Office (Outlook, Word, and Excel).
• Must be able to work 8 am - 4 pm EST (training is required on-camera).
• Effective troubleshooting, research, analysis, and problem-solving abilities.
• Strong time management skills with the ability to cope in a complex, changing environment.
• Ability to communicate (oral/written) effectively in a professional office setting.

• Experience with Xcelys is preferred.

NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.