Claims Examiner at NTT DATA

Plano, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Mar, 26

Salary

0.0

Posted On

09 Dec, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Data Entry, Attention To Detail, Analytical Skills, Communication Skills, Healthcare Insurance Knowledge, Policy And Procedure Compliance, Problem Solving, Time Management, Adjudication, Medical Claims, Prioritization, Software Navigation, Client Interaction, Quality Standards, Productivity Goals

Industry

IT Services and IT Consulting

Description

In these roles you will be responsible for: Review and process insurance claims. Validate Member, Provider and other Claim's information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines University degree or equivalent that required formal studies of the English language and basic Math 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product. 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 6+ months of experience that required prioritizing your workload to meet deadlines Ability to communicate (oral/written) effectively to exchange information with our client. Commerce graduate with English as a compulsory subject 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills

Responsibilities

The Claims Examiner will review and process insurance claims, validate information, and determine payment criteria based on policies. They will also maintain productivity goals and ensure timely completion of transactions.