Claims Examiner Remote

HC & Insurance Operations Processing Sr Rep

NTT DATA Services is seeking a HC & Insurance Operations Processing Sr Rep to join our team in Plano, Texas (US-TX), United States (US). In this role, the candidate will be responsible for:

• Processing of professional claim forms files by provider
• Reviewing the policies and benefits
• Complying with company regulations regarding HIPAA, confidentiality, and PHI
• Abide with the timelines to complete compliance training of NTT Data/Client
• Working independently to research, review and act on the claims
• Prioritizing work and adjudicating claims as per turnaround time/SLAs
• Ensuring 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 calculating claims payable amount using applicable methodology/fee schedule

Requirements:

• 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 o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences:

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

Sierra Systems, An Ntt Data Company