NTT DATA is seeking a Claims Processing Senior Representative to support our end client remotely. In this role, you will be responsible for processing professional healthcare claims, ensuring compliance with regulations, and consistently meeting productivity and quality targets.
What You'll Do
- Process professional claim forms files by provider.
- Review policies and benefits.
- Comply with company regulations regarding HIPAA, confidentiality, and PHI.
- Abide by timelines to complete compliance training for NTT Data and the client.
- Work independently to research, review, and act on claims.
- Prioritize work and adjudicate claims according to turnaround times and SLAs.
- Ensure claims are adjudicated per the client's defined workflows and guidelines.
- Sustain and meet the client's productivity and quality targets to avoid penalties.
- Maintain and sustain quality scores above 98.5% PA and 99.75% FA.
- Provide timely response and resolution to claims received via emails as priority work.
- Correctly calculate claims payable amounts using applicable methodology and fee schedules.
What We're Looking For
- 3 year(s) of hands-on experience in Healthcare Claims Processing.
- 2+ year(s) using a computer with Windows applications, navigating multiple screens and systems, and learning new software tools.
- A high school diploma or GED.
- Previous experience performing in a P&Q work environment, working from a queue, and working remotely.
- Strong keyboard skills and computer familiarity, including toggling between multiple screens and systems.
- Working knowledge of MS Office products – Outlook, MS Word, and MS Excel.
Nice to Have
- Experience with Amisys.
- Ability to communicate effectively (oral and written) in a professional office setting.
- Effective troubleshooting skills leveraging research, analysis, and problem-solving abilities.
- Strong time management skills with the ability to cope in a complex, changing environment.
Technical Stack
- Amisys
- Windows applications
- MS Office (Outlook, Word, Excel)
Work Mode
This is a fully remote position.
NTT DATA is an equal opportunity employer.
