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Remote Claims Examiner (Plano, TX, US) bei NTT DATA

NTT DATA · Plano, Vereinigte Staaten Von Amerika · Remote

Microsoft Excel

Microsoft Outlook

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In this Role the candidate will be responsible for:
  • 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
  • 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 7am - 4 pm CST online/remote
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