Medical Claims Examiner Remote

Req ID: 381689

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Medical Claims Examiner Remote to join our team in Plano, Texas (US-TX), United States (US).

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. 
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:
•    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

About NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, 

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