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Medical Claims Processor

Role overview

Qualifications

  • 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

Responsibilities

  • Processing of Professional and Hospital claim forms files by provider
  • Reviewing the policies and benefits
  • Comply with company regulations regarding HIPAA, confidentiality, and PHI
  • Timely response and resolution of claims received via emails as priority work

Key facts

Other skills

  • Troubleshooting (Problem Solving)
  • Problem Solving
  • Time Management

About the company

NTT DATA logo

NTT DATA

IT Services & IT Consulting

NTT DATA – a part of NTT Group – is a trusted global innovator of IT and business services headquartered in Tokyo. We help clients transform through consulting, industry solutions, business process services, digital & IT modernization and managed services. NTT DATA enables them, as well as society, to move confidently into the digital future. We are committed to our clients’ long-term success and combine global reach with local client attention to serve them in over 50 countries around the globe.

Company details

Company typeXLarge
IndustryIT Services & IT Consulting
Company size10001

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Job description

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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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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