HC & Insurance Operations Processing Sr Rep (Plano, TX, US)

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team.  In this Role the candidate will be responsible for: •    Processing of Professional 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

Requirements: •    3 year(s) hands-on experience in Healthcare Claims Processing •    2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools •    High school diploma or GED. •    Previously performing – in P&Q work environment; work from queue; remotely •    Key board skills and computer familiarity – o    Toggling back and forth between screens/can you navigate multiple systems. o    Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences: •    Amisys •    Ability to communicate (oral/written) effectively in a professional office setting •    Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities •    Time management with the ability to cope in a complex, changing environment