Claims Examiner Remote

NTT
Plano
Workplace: RemoteFull timeFunction: Insurance & ActuarialEducation: bachelorsSkills: ["Communication","Troubleshooting","Research","Analysis","Time management"]

Process professional healthcare claim forms for an end client, reviewing policies and benefits while ensuring HIPAA, confidentiality, and PHI compliance. Independently research, review, and adjudicate claims while meeting turnaround-time/SLAs and client workflows. Accurately calculate payable amounts using applicable methodologies and fee schedules, respond to email claim inquiries, and maintain high quality scores and productivity targets.

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FursaFursa
NTT
NTT
1 week ago

Claims Examiner Remote

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Source: Company careers pageValidated by: Fursa AI
Last checked: 15 hours agoStatus: Live

Job Summary

Process professional healthcare claim forms for an end client, reviewing policies and benefits while ensuring HIPAA, confidentiality, and PHI compliance. Independently research, review, and adjudicate claims while meeting turnaround-time/SLAs and client workflows. Accurately calculate payable amounts using applicable methodologies and fee schedules, respond to email claim inquiries, and maintain high quality scores and productivity targets.
Location: Plano
Workplace: Remote
Employment Type: Full time
Job Function: Insurance & Actuarial
Seniority: Mid level

Key Responsibilities

  • •Process professional claim forms by provider.
  • •Review policies and benefits while complying with HIPAA, confidentiality, and PHI requirements.
  • •Research, review, and act on claims independently.
  • •Prioritize work and adjudicate claims according to turnaround-time/SLAs and defined client workflows.
  • •Calculate claims payable amounts using applicable methodology/fee schedule and maintain quality and productivity targets.

Key Requirements

  • •3 years of hands-on experience in healthcare claims processing.
  • •2+ years using a computer with Windows applications to navigate multiple screens and systems and learn new software tools.
  • •High school diploma or GED.
  • •Experience performing work in a P&Q (work from queue) environment, remotely.
  • •Keyboard skills and computer familiarity, including toggling between screens and navigating multiple systems.
Experience:HealthcareHealthcare claims processing
Education:Bachelor's
Skills:CommunicationTroubleshootingResearchAnalysisTime management
Tech Stack:WindowsMS OfficeOutlookMS WordMS ExcelAmisys

Company Brief

NTT
Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Valuation: Public Company (Market Cap in USD)
Headquarters: London, United Kingdom
Founded: 1983
WebsiteLinkedIn