Medical Claims Examiner Job at NTT DATA (Plano)

Claims Examiner Senior

The Claims Examiner Senior is responsible for reviewing, analyzing, researching,...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate's degree or equivalent job-related experience required
Minimum of 3 years’ experience processing medical claims in the healthcare industry
Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies
Must have excellent written, verbal, organizational and interpersonal communication skills
Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills

Job Responsibility

Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations
Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc
Work claim projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes
Process provider refunds, reconsiderations, and direct member reimbursements
Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication
Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager
Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes
Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management
Sets high standards of performance and promotes teamwork to achieve established team goals, while maintaining a positive, professional attitude
Contacting/responding to internal and external customers for resolution on claim issues

Fulltime

Medical Claims Representative

This position examines, enters and accurately adjudicates medical, dental, visio...

Location

United States , Fort Wayne

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High School Diploma or GED required
Medical terminology and medical claims experience with involvement in reviewing and analyzing claims is beneficial
Must be able to work well independently and in a team atmosphere
Ability to maintain a departmental accuracy standard of 99%
Detail oriented
Ability to manage multiple priorities that change from day-to-day and week-to-week in a fast-paced environment
Ability to understand system calculations in order to determine if claims are adjudicating accurately
Ability to manually process claims in the claims adjudication system if necessary
Must understand complicated benefit designs
Ability to self-manage, prioritize and meet specific production deadlines

Job Responsibility

Examines, enters and accurately adjudicates medical, dental, vision, HRA, FLEX, or STD claims based upon coverage, policy and procedural guidelines
Enters paper claims into a proprietary claim adjudication system
Adjudicates both paper and electronic claims with 99% accuracy for payment dollars and claim coding following an extensive on-the-job training class
Maintains strict first-in/first-out for claims adjudication
Follows office procedures for follow-up on claims needing additional information by reviewing the Holding for Information Report for each assigned client on a monthly basis
Adjudicates prescription claims not automatically adjudicated by the claim adjudication system
Interprets COB and Medicare worksheets as needed on assigned clients
Batches adjudicated claims according to client preference or schedule
Reports to clients on a weekly basis the total of all claims processed for that client, requesting the funding or requesting that funding be transferred to Pro-Claim
Communicates with brokers, agents and clients regarding high dollar cost claims and SPEC claimants

What we offer

Medical, vision, dental, and life and disability insurance
Eligible to enroll in company 401(k) plan

Fulltime

Claims Officer

The role of Claims Officer involves processing medical claims for clients in the...

Location

Philippines , Makati

Salary:

Not provided

Allianz

Expiration Date

Until further notice

Requirements

1-2 years experience in a Medical Claims role is required
Strong Knowledge of Microsoft Office (Excel, Word)
A highly customer-focused individual with strong interpersonal, communicative and accuracy skills
Team player
Ability to demonstrate sounds work ethics
Can work with minimal supervision and comfortable working with deadlines
Must be willing to work onsite in Makati first 6 months
Fluent English

Job Responsibility

Examine and process Claims within the agreed company SLA to guarantee customer satisfaction and retention
Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning
Contribute to the team and departmental productivity targets so that the agreed SLA is achieved
In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims
Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction

What we offer

Competitive Salary
13th and 14th month guaranteed
Performance Incentive Plan / Yearly Bonus
Retirement Program and Group Life Insurance
Hybrid Work Set-up after 6 months of employment
Be part of a pioneer team

Fulltime

Workers Compensation Lost Time Senior Claim Examiner

We are currently seeking an experienced Workers Compensation Lost Time Senior Cl...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience handling workers compensation lost time claims required
Certification to manage California Workers Compensation claims required
Experience handling claims in CO, UT, NV, and AZ is a plus
Strong communication and analytical skills
Proficient in Microsoft Office and electronic claim systems
Familiarity with medical terminology and bill processing
Proven organizational and time management skills
Ability to manage multiple priorities and meet deadlines consistently
Commitment to high-quality work and service standards
Must obtain or maintain applicable state adjuster licenses as required

Job Responsibility

Manage all aspects of lost time workers compensation claims from initiation through closure
Conduct three-part investigations, including statements from insureds, claimants, and medical providers
Determine claim compensability based on investigation outcomes
Administer statutory medical and indemnity benefits timely and accurately
Communicate denials and updates to insureds, claimants, attorneys, and involved parties
Set and adjust reserves within authority, escalating when necessary
Collaborate with legal counsel on hearings and litigation matters
Direct vendors and medical case managers on return-to-work strategies
Comply with all state and regulatory reporting requirements
Refer appropriate claims for subrogation and maximize recovery efforts

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

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