Claims Examiner - Xcelys Remote, Temporary

NTT
Plano
Workplace: RemoteFull timeFunction: Insurance & ActuarialSkills: ["Communication","Attention to detail","Compliance mindset","Problem identification"]

Review and resolve written provider dispute requests for denied or incorrect payments across professional and institutional claims. Interpret provider and health plan contracts to ensure correct claim determinations, including RBRVS and Medicare guideline application. Adjust claims as needed, monitor compliance warnings, and update the Provider Dispute Database with outcomes and documentation to support internal and external reporting.

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FursaFursa
NTT
NTT
1 week ago

Claims Examiner - Xcelys Remote, Temporary

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Last checked: 3 hours agoStatus: Live

Job Summary

Review and resolve written provider dispute requests for denied or incorrect payments across professional and institutional claims. Interpret provider and health plan contracts to ensure correct claim determinations, including RBRVS and Medicare guideline application. Adjust claims as needed, monitor compliance warnings, and update the Provider Dispute Database with outcomes and documentation to support internal and external reporting.
Location: Plano
Workplace: Remote
Employment Type: Full time
Job Function: Insurance & Actuarial

Key Responsibilities

  • •Review written dispute requests for denied or incorrect payments for professional and institutional claims.
  • •Adjust claims as appropriate, including calculation of interest and penalties when applicable.
  • •Identify potential issues affecting claims processing accuracy (e.g., system configuration, benefits, eligibility, authorizations) and forward them with documentation to the appropriate internal department.
  • •Manage workload to ensure efficient and compliant resolution of disputes, including monitoring warning reports and requesting special check runs as needed.
  • •Document dispute outcomes in the Provider Dispute Database and communicate resolution to providers using system-formatted letters.

Key Requirements

  • •Ability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services per contract terms and financial responsibility.
  • •Ability to apply RBRVS and Medicare guidelines for contracted and non-contracted providers.
  • •Ability to identify issues related to system configuration, benefits, eligibility, or authorizations that affect accurate claims processing and route them to the correct internal department.
  • •Ability to communicate dispute outcomes to providers in writing using system-formatted letters clearly and concisely.
  • •Ability to document each dispute accurately in the Provider Dispute Database for reporting purposes.
Skills:CommunicationAttention to detailCompliance mindsetProblem identification

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