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NTT DATA North America is seeking a Remote Medical Claims Processor to support healthcare claims processing operations for its client team. This opportunity is ideal for candidates with experience in healthcare claims processing, strong computer skills, and the ability to manage detailed workflows while maintaining accuracy and compliance.
The selected candidate will review and process professional claim forms, verify policies and benefits, calculate payable amounts, and ensure claims are handled according to client guidelines and service level requirements. Applicants must be comfortable working remotely, managing multiple systems, and maintaining high-quality performance standards in a fast-paced environment.
Key Responsibilities:
• Process professional healthcare claim forms submitted by providers.
• Review insurance policies, benefits, and applicable claim details.
• Research, analyze, and resolve claims independently while following defined workflows.
• Adjudicate claims according to client guidelines, turnaround times, and service level agreements.
• Calculate claim payable amounts using applicable methodologies and fee schedules.
• Maintain compliance with HIPAA, confidentiality requirements, and protected health information (PHI) regulations.
• Respond to claims-related emails and resolve priority requests in a timely manner.
• Maintain required productivity and quality standards.
• Complete required compliance training within specified timelines.
Requirements:
• 1–3 years of experience in Healthcare Claims Processing.
• High School Diploma or GED.
• Experience working with computer systems, multiple screens, and software applications.
• Ability to navigate multiple systems and perform accurate data processing.
• Working knowledge of Microsoft Office products, including Outlook, Word, and Excel.
• Experience working remotely in a productivity and quality-focused environment.
• Strong troubleshooting, research, analytical, and problem-solving skills.
• Excellent time management skills with the ability to work in a changing environment.
• Strong written and verbal communication skills.
• Ability to work remotely from 7:00 AM to 4:00 PM CST, including required on-camera training.
• Knowledge of Amisys is preferred.
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