Medical Claims Processor

Job Title : Medial Claims Processor

Industry : Healthcare

FSLA status : Non-Exempt

Department : Operations

Level : Entry to mid-level

Location : Work at Home

Pay Rate: 17.00-18.00

In this Role the candidate will be responsible for:

• Processing of Professional and Hospital 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/

Required Skills for this role include:

• 2+ year(s) of Medical Claims experience

• 2+ year(s) using a computer with Windows applications that required you to use a keyboard, navigate multiple screens and computer systems, and learn new software tools

• 1+ years of working with Claims Adjudication Systems

• High School diploma or equivalent

Preference

• Ability to communicate (oral/written) effectively in a professional office setting

• Effective troubleshooting skills where you can leverage your research, analysis and problem-solving skills

• Time management skills that require the ability to cope with a complex, changing environment

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $17.00-18.00. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits .

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