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Medical Claims Specialist

2 months ago

Des Moines, Iowa, United States NTT DATA Full time

Job Summary:

NTT DATA's Client is seeking a skilled Medical Claims Specialist to join their team. As a Claims Processing Associate, you will be responsible for processing professional and hospital claim forms, reviewing policies and benefits, and ensuring compliance with company regulations.

Key Responsibilities:

  • Process professional and hospital claim forms files by provider
  • Review 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 claims
  • Prioritize work and adjudicate claims as per turnaround time/SLAs
  • Ensure claims are adjudicated as per clients defined workflows, guidelines
  • Sustain and meet client productivity/quality targets to avoid penalties
  • Maintain and sustain 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:

  • 1+ year(s) of experience in a role that required a focus on quality, including attention to detail, accuracy, and accountability of work
  • 2+ year(s) using a computer with Windows applications that required you to use a keyboard, navigate multiple screens, and computer systems, and learn new software tools
  • Education level of at least a high school diploma or GED
  • Understanding of previous quality, production, and attendance parameters
  • Understanding and adhering to working hours and leave policy
  • Key board skills and computer familiarity
  • Typing test required
  • Familiar with toggling back and forth between screens/can you navigate multiple systems
  • Working knowledge of MS office products like - Outlook, MS word, and MS-excel

Preferred Qualifications:

  • Ability to communicate (oral/written) effectively in a professional office setting
  • Effective troubleshooting skills where you can leverage your research, analysis, and problem-solving skills
  • Time management skills that require the ability to cope with a complex, changing environment

Compensation and Benefits:

The starting hourly range for this remote role is $18.00-$18.00. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance. This position is eligible for company benefits that will depend on the nature of the role offered.