NTT DATA is seeking a Healthcare Claims Processing Senior Representative to join our team. In this remote role, you will process healthcare claims, review policies, and ensure compliance with regulations. You'll work independently to research and prioritize tasks to meet service level agreements.
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 our 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 client-defined workflows and guidelines
- Sustain and meet client productivity and quality targets to avoid penalties
- Maintain quality scores above 98.5% PA and 99.75% FA
- Provide timely response and resolution for claims received via emails as priority work
- Correctly calculate claims payable amounts using applicable methodology or fee schedules
What We're Looking For
- 3+ years of hands-on experience in Healthcare Claims Processing
- 2+ years using a computer with Windows applications, using a keyboard, navigating multiple screens and systems, and learning new software tools
- High school diploma or GED
- Experience performing in a production and quality (P&Q) work environment, working from a queue, and working remotely
- Strong keyboard skills and computer familiarity, including toggling between screens and navigating multiple systems
- Working knowledge of MS Office products, including Outlook, MS Word, and MS Excel
Nice to Have
- Experience with Amisys
- Ability to communicate effectively, both orally and in writing, in a professional office setting
- Effective troubleshooting skills leveraging research, analysis, and problem-solving abilities
- Strong time management with the ability to cope in a complex, changing environment
Technical Stack
- Windows applications
- MS Office (Outlook, Word, Excel)
- Amisys
Team & Environment
You will work for our end client and their team.
Work Mode
This is a fully remote position.
NTT DATA is an equal opportunity employer.
