Claims Examiner Remote

NTT Data Services is Hiring! Grade 3 - HC & Insurance Operations Sr Rep Position's Overview At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company’s growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring, the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. Client's business problem to solve? Our Client is one of Leading Health Plans in the US providing services in Florida state, and NTT is contracting with the Client to manage End to End Claims Administration services. Our NTT Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients to bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction. Position's General Duties and Tasks In these roles you will be responsible for: Review and process insurance claims. Validate Member, Provider and other Claim’s information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinize medical claim documents and settlements. Organize and complete tasks per assigned priorities. Develop and maintain a solid working knowledge of the healthcare insurance industry and all products, services and processes performed by the team. Resolve complex situations following pre-established guidelines. Requirements for this role include: University degree or equivalent that required formal studies of the English language and basic Math. 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions. 6+ months of data entry experience that required a focus on quality, including attention to detail, accuracy, and accountability for your work product. 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 6+ months of experience that required prioritizing your workload to meet deadlines. Preferences (Optional) Ability to communicate (oral/written) effectively to exchange information with our client. Commerce graduate with English as a compulsory subject. Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend basis as a business requirement. #J-18808-Ljbffr NTT DATA North America