Healthcare Senior Level Claims Examiners (Payer Side)

Healthcare Sr. Claims Examiner

At NTT DATA Services, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA Services and for the people who work here.

NTT Data Services,

formerly known as Dell Services

has the opportunity to assist our

client in placing a LOCAL candidate in this

temp Contract to Hire position.

On behalf of our client,

NTT DATA Services, Corporation is currently seeking a Sr. Claims Examiner

with payer side healthcare experience to join our client’s team. They

are a growing Third Party Administrator working with clients across the US.

Role Responsibilities:
Timely and accurate adjudication of all types of claims

from assigned workflow queues.

Compliance with state, federal and contractual

requirements to Claims Administration.

Performance standards of 15 claims/hour with 97% or

above financial and procedural quality & accuracy rates.

Demonstrate a thorough knowledge of the Plan’s claims

processing procedures as provided in training materials and proficiency

with the core and ancillary system applications.

Demonstrates the ability to think analytically to

resolve complicated claim issues and identify appropriately when to

escalate issues for review.

Demonstrates a thorough knowledge of regulatory

requirements, individual plan benefits, provider contracts, policies and

procedures for product assignment.

Claim analysis of coding and billing compliance,

potential third party liability, accurate coordination of benefits (COB),

benefit application including limitations and restrictions, pre-existing

conditions, subrogation, medical necessity and other claim investigation

as appropriate.

Accurate and timely review of claim pricing to

facilitate manual pricing as necessary, working with various Health Plan

provider networks.

Complete all mandatory claims training/refresher

courses.

Effectively communicates with members and providers

verbally and in writing regarding claim issues including claim

adjudication, subrogation, and over payments or billing problems.

Actively participates and supports department and

organization-wide efforts to improve efficiencies while supporting

departmental goals and objectives.

Complete all mandatory compliance and corporate

training.

Must be able to adapt to a changing work priorities and

requirements and perform other duties as directed to support the overall

functions of Claims Administration and support of staff without boundaries

within the Plan.

Qualifications

Requirements

High school diploma or equivalent required.

Must have 2 – 5 years of relevant experience in insurance/healthcare industry to support our clients. Experience will need to be with an insurance, managed care or TPA Company.

Possess high productivity and quality standards within a claims processing environment.

Knowledge of CPT, HCPC, ICD-9, ICD-10 codes.

Knowledge of HMO, PPO Medicare and Medicaid plans, as well as experience with Medicare Part D,

Knowledge of Medical terminology.

Preferences

Associates degree, technical college or some college course work preferred

Knowledge of one more of the following claims paying systems will be considered: AMISYS, AMISYS Advance, AMISYS Release 4 or 6, NASCO, FACETS, EZ-Cap, Rims, Qcare, Xcelys Diamond, NextGen, QNXT, ITS, IKA, WGS, Call Care Browser, GBAS, Genelco, Tapestry, or HEALTHsuite

Local or National candidates with experience with LuminX will be strongly considered

PLEASE SUBMIT A WORD DOC OF YOUR RESUME. THANKS!

About NTT DATA Services

NTT DATA Services, Inc., together with its subsidiaries, is a leading business and IT services provider and global innovation partner, and part of the NTT DATA Services family of companies, with 80,000 professionals based in over 40 countries. NTT DATA Services combines global reach and local intimacy to provide premier professional services, including consulting, application services, business process and IT outsourcing, and cloud-based solutions. NTT DATA Services is part of NTT Group, one of the world’s largest technology services companies, generating more than $100 billion in annual revenues, and partner to 80% of the Fortune Global 100. Visit www.nttdata.com/americas to learn how our consultants, projects, managed services, and outsourcing engagements deliver value for a range of businesses and government agencies.

Equal Opportunity Employer Policy

NTT DATA Services, Inc. (the “Company”) is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.