Claims Examiner

Position

Claims Examiner at NTT DATA North America

• Review and process insurance claims.
• Validate member, provider and other claim information.
• Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
• Coordinate claim benefits according to policy and procedure.
• Maintain productivity goals, quality standards and aging time frames.
• Scrutinize medical claim documents and settlements.
• Organize and complete tasks according to assigned priorities.
• Develop and maintain a solid working knowledge of the healthcare insurance industry and all team products, services and processes.
• Resolve complex situations following pre-established guidelines.
• Process adjudication claims and resolve for payment and denials.
• Handle authorization, COB, duplicate, pricing and corrected claims processes.
• Apply knowledge of healthcare insurance policy concepts, including in‑network, out‑of‑network, deductible, coinsurance, copay, out‑of‑pocket, maximum limits and exclusions.
• Ensure accurate and timely completion of transactions to meet or exceed client SLAs.

• University degree or equivalent, with formal studies in English language and basic math.
• 1–3 years of experience processing claims adjudication and adjustment processes.
• Experience with Faces (Facets) is an added advantage.
• Experience in professional (HCFA) or institutional (UB) claims (optional).
• Both under‑graduates and post‑graduates can apply.
• Strong communication skills (reading comprehension, writing, and oral).
• Ability to work independently with strong analytical skills.
• Prior experience prioritizing workload to meet deadlines.
• Experience applying business rules to varied fact situations and making appropriate decisions.
• Experience with data entry requiring quality focus, accuracy and accountability.
• Proficiency with Windows PC applications, keyboard usage, screen navigation and learning new software tools.

• Ability to communicate orally and in writing effectively with clients.
• Commerce graduate with English as a compulsory subject.

Required schedule availability:
Monday–Friday, 06:00 pm – 04:00 am IST. Shift timings may be changed per client requirements. Overtime and weekend work may be required as business needs dictate.

• Seniority level:
  Entry level
• Employment type:
  
  Full‑time
• Job function:
  Finance and Sales
• Industries: IT Services and IT Consulting