Medical Claims Processor

APPLY TO THIS JOB

In this Role the candidate will be responsible for:

• Processing of Professional and Hospital 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/

• 2+ year(s) of Medical Claims experience
• 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
• 1+ years of working with Claims Adjudication Systems
• High School diploma or equivalent