NTT DATA Services strives to hire exceptional, innovative and passionate individuals who want to grow with us.
In this Role you will be Responsible For
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
Requirements For This Role Include
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
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