Claims Examiner - Xcelys Remote, Temporary

NTT
Plano
Workplace: RemoteFull timeFunction: Insurance & ActuarialSkills: ["Contract interpretation","Compliance orientation","Written communication","Organization","Problem identification"]

Review written dispute requests for denied or incorrect payments for professional and institutional claims. Interpret provider and health plan contracts to verify accurate claim determinations, including RBRVS and Medicare guidelines, and adjust claims when needed. Identify issues impacting claims processing (e.g., configuration, benefits, eligibility, authorizations) and route them internally with supporting documentation. Manage dispute workflows, monitor warning reports for compliance, and communicate dispute outcomes to providers using standardized letters.

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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 written dispute requests for denied or incorrect payments for professional and institutional claims. Interpret provider and health plan contracts to verify accurate claim determinations, including RBRVS and Medicare guidelines, and adjust claims when needed. Identify issues impacting claims processing (e.g., configuration, benefits, eligibility, authorizations) and route them internally with supporting documentation. Manage dispute workflows, monitor warning reports for compliance, and communicate dispute outcomes to providers using standardized letters.
Location: Plano
Workplace: Remote
Employment Type: Full time
Job Function: Insurance & Actuarial

Key Responsibilities

  • •Review dispute requests for denied or incorrect payments and determine next actions for professional and institutional claims.
  • •Interpret provider and health plan contracts, ensuring decisions align with contractual terms and financial responsibility requirements.
  • •Adjust claims as needed, including interest and penalty calculations when applicable.
  • •Identify and forward system and eligibility-related issues impacting accurate claims processing; ensure documentation is attached and follow up with internal teams.
  • •Manage dispute workflow and compliance by monitoring warning reports, requesting special check runs as needed, documenting outcomes in the Provider Dispute Database, and communicating dispute results to providers in writing.

Key Requirements

  • •Ability to interpret provider and health plan contracts to ensure accurate payment or denial decisions.
  • •Knowledge of RBRVS and Medicare guidelines applicable to contracted and non-contracted providers.
  • •Ability to adjust claims as appropriate, including calculation of interest and penalties when applicable.
  • •Ability to identify issues related to system configuration, benefits, eligibility, and authorizations affecting claims processing and route them to the correct internal department with documentation.
  • •Ability to document disputes accurately in the Provider Dispute Database and maintain department quality and compliance standards.
Skills:Contract interpretationCompliance orientationWritten communicationOrganizationProblem 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