[Remote] HC & Insurance Operations Processing Sr Rep

Note: The job is a remote job and is open to candidates in USA. NTT DATA is seeking a Remote Claims Processing Associate to work for an end client. The role processes and adjudicates healthcare claims, reviews policies and benefits, and ensures claims meet client workflows, quality standards, and turnaround times.

Responsibilities

• 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

Skills

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

Benefits

• Remote work

Company Overview

Company H1B Sponsorship