Medical Claims Processor, Remote

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team.

In this Role the candidate will be responsible for :

• 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

Requirements :

o  Toggling back and forth between screens / can you navigate multiple systems.

o  Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences :