NTT DATA Services strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
We are currently seeking a [] to join our team in Gurgaon, HaryÄna (IN-HR),India (IN).In this Role you will be Responsible For
Requirements For This Role Include
- Review and process insurance claims.
- Validate Member, Provider and other Claims information.
- Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
- Coordination of Claim Benefits based on the Policy & Procedure.
- Maintain productivity goals, quality standards and aging timeframes.
- Scrutinizing Medical Claim Documents and settlements.
- Organizing and completing tasks per assigned priorities.
- Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea
- Resolving complex situations following pre-established guidelines
Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekendâs basis business requirement.
- University degree or equivalent that required formal studies of the English language and basic Math
- 2 to 3 Years of experience in Claims Adjudication/Adjustments that required a working knowledge of HCPCS, ICD and CPT codes.
Experience that required a knowledge of healthcare insurance policy concepts including In Network, Out of Network providers, Deductible, Coinsurance, Co-pay, Out of Pocket, Maximum inside limits and Exclusions, State Variations.
Experience in Claims Platform AMISYS or Xcelys is preferrable