<span>Claims Examiner - Remote (HealthRules required)</span>
$37,440 - $49,920/Yr
NTT DATA - Dallas, TX
posted 18 days ago
Full-time - Entry Level
Remote - Dallas, TX
1,001-5,000 employees
Professional, Scientific, and Technical Services
About the position
The Claims Examiner position at NTT DATA involves processing medical claims, ensuring compliance with regulations, and maintaining high-quality standards. The role requires independent work to review and adjudicate claims while adhering to defined workflows and timelines.
Responsibilities
- Processing of Professional claim forms files by provider
- Reviewing the policies and benefits
- Complying with company regulations regarding HIPAA, confidentiality, and PHI
- Abiding 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
Requirements
- 2+ years of experience in medical claims processing
- 1+ year of experience processing claims with HealthRules or Visual Basic
- High school diploma or GED
Benefits
- Remote work opportunity
- Competitive hourly wage of $18 - $24
- Diverse and inclusive work environment
- Opportunities for professional development
