Medical Claims Examiner – REMOTE

Requirements For The Responsibilities You Will Be Tasked With

• 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

• 1+ year(s) of experience in a role that required a focus on quality including attention to detail, accuracy and accountability of work
• 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
• An education level of at least a high school diploma or GED.
• Understanding of previous quality, production and attendance parameters,
• Understanding and adhering to working hours and leave policy.
• Key board skills and computer familiarity –
• You will be required to take a typing test doing the prescreen process.
• Must be familiar with toggling back and forth between screens and navigating multiple systems.
• Working knowledge of MS office products like – Outlook, MS word and MS-excel.

Preferred Skills

• 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
• All new hires will be required to successfully complete our training classes and demonstrate proficiency of the material ***

About NTT DATA Services

NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients’ long-term success. Visit nttdata.com or LinkedIn to learn more.

About NTT Data

NTT DATA is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients’ long-term success. Visit nttdata.com or LinkedIn to learn more.

NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is 16-18. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of 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.