Medical Claims Examiner Remote

NTT Data is Hiring!

Medical Claims Examiner - Remote

* 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

Requirements:

* 1-3 year(s) hands-on experience in Healthcare Claims Processing, Claims Adjustments.

* 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools

* High school diploma or GED.

* Previously performing - in P&Q work environment; work from queue; remotely

* 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.

* Must be able to work 8 am - 4:30 pm EST online/remote (training is required on-camera).

* 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

* High School Diploma

Preferred Skills & Experiences:

* Amisys or Xcelys preferred.