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

Claims Assistant

Robert Half's client in Walnut Creek, CA is seeking a Claims Assistant for a lon...

Location

United States , Pleasant Hill

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Interest in claims, healthcare administration, or insurance operations
Comfort working with detailed records, forms, and data
Strong organization, follow-through, and attention to detail
Clear, professional communication skills
Ability to manage multiple tasks and deadlines
Willingness to learn Workers’ Compensation regulations and internal best practices
Proficiency with office software and standard office tools
Experience providing administrative support in a claims, insurance, medical, or similar office environment
Working knowledge of workers’ compensation processes, insurance claims handling, or medical claims documentation
Familiarity with medical terminology and the ability to interpret reports and supporting records accurately

Job Responsibility

Support the processing of Workers’ Compensation claims, with a focus on medical-only and indemnity claims
Keep claims moving by tracking documentation, reviewing medical reports, and ensuring accuracy and compliance
Prepare benefit payments, authorizations, and invoices
Communicate with claimants, school districts, medical providers, and partner agencies
Calculate benefits, enter and maintain claim data, and manage claim files
Schedule medical evaluations and coordinate provider follow-ups
Track employee work status and support return-to-work efforts
Assist Claims Examiners and contribute to special projects as needed

What we offer

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

Fulltime

New

Medical Claims Analyst

We are looking for a detail-oriented Medical Claims Analyst to join a team suppo...

Location

United States , Raleigh

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2–5 years of experience in Medicaid, healthcare claims, or audit-related roles
Hands-on knowledge of medical claims processing, claim denials, rejected claims, and medical billing practices
Familiarity with Medicaid billing requirements and provider-focused audit or program integrity work
Ability to evaluate documentation, perform testing, and apply regulatory guidance to support sound conclusions
Strong analytical skills with the ability to organize findings and maintain thorough audit records
Effective written and verbal communication skills for presenting issues and collaborating with cross-functional teams
Proficiency in reviewing claim data and identifying inconsistencies, risks, or compliance concerns

Job Responsibility

Review provider billing records and medical claim activity to identify discrepancies, validate payments, and assess adherence to Medicaid guidelines
Carry out structured audit procedures for claims, denials, rejected claims, and billing documentation to support program integrity efforts
Interpret applicable Medicaid requirements and federal regulatory standards when analyzing audit results and determining potential issues
Develop clear working papers, summaries, and preliminary findings that accurately document testing performed and conclusions reached
Partner with internal stakeholders to clarify claim exceptions, address audit questions, and support corrective action recommendations
Analyze medical billing and Medicaid claim data to detect patterns, trends, and areas requiring additional review
Contribute to compliance examinations involving provider assessments, payment verification, and operational claim review activities

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

New

Claims Examiner - Xcelys

The Claims Examiner position at NTT DATA requires a minimum of 3 years of claims...

Location

United States , Ontario

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3+ years claims adjudication experience
Minimum of 1 year experience in Xcelys
2+ years in coding (CPT, ICD-10, HCPCS)
2+ years provider contracts, pricing, regulatory guidelines experience
Verifiable high school diploma or GED

Job Responsibility

Process comprehensive medical claims using Xcelys and associated subsystems
Resolve complex pends, coding issues, and contract exceptions
Author overpayment/underpayment determinations and coordinate appeals
Engage in quality reviews, audits, root cause analyses
Monitor accuracy, variance, and rework metrics
Ensure alignment with regulatory and internal compliance guidelines
Act as escalation point and subject matter expert
Participate in system testing, UAT, and workflow enhancements
Recommend improvements, document system and process changes
Prepare production, pending, and quality reports

Fulltime

Claims Examiner

We are seeking a detail-oriented Claims Examiner to join a fast-paced, customer-...

Location

United States , New Haven

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of Claims Examiner experience or related transferable experience
Knowledge of workers’ compensation regulations (preferred but not required)
Excellent analytical and problem-solving skills
Strong communication (verbal and written) abilities
Ability to manage multiple priorities and meet deadlines
High attention to detail and organizational skills
Proficiency in Microsoft Office
Ability to collaborate effectively with cross-functional teams
Commitment to delivering high-quality customer service

Job Responsibility

Manage workers’ compensation claims from setup through closure
Review claim and policy information to support investigations
Conduct thorough investigations, including gathering statements from claimants, insured parties, and medical providers
Determine claim compensability based on collected facts
Communicate claim decisions, including denials, to relevant stakeholders
Prepare detailed reports on investigations, settlements, and claim evaluations
Administer statutory medical and indemnity benefits in a timely manner
Set and adjust reserves within authority limits and recommend changes as needed
Monitor claim progress and recommend corrective actions to leadership
Coordinate with attorneys on hearings and litigation

What we offer

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

Fulltime

Medical Claims Auditor

We are looking for an experienced Medical Claims Auditor to join our team in Eme...

Location

United States , Emeryville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

A minimum of 7 years of experience in medical coding, auditing, and claims processing
Strong knowledge of ICD-10 and CPT codes, along with certified coding credentials
Expertise in auditing insurance claims and ensuring compliance with state and federal regulations
Proven ability to conduct training sessions and develop educational resources for team members
Familiarity with Medi-Cal and the California Knox-Keene Act
Exceptional analytical skills to identify trends and resolve complex claim issues
Proficiency in preparing statistical reports and presenting findings to stakeholders
Strong communication skills and the ability to collaborate effectively with diverse teams

Job Responsibility

Conduct detailed audits of paid, pending, and denied medical claims to ensure proper coding, adherence to benefit rules, and compliance with state and federal regulations, including the California Knox-Keene Act and Medi-Cal
Design and deliver comprehensive training programs for Claims Examiners, focusing on workflows, updated policies, and emerging technologies
Investigate complex claim issues, including provider disputes and appeals, and identify trends to propose effective corrective actions
Compile and maintain detailed statistical and quality reports, presenting audit findings and staff performance metrics to management
Stay informed about federal and state billing laws, including Medicare guidelines, to ensure compliance during health plan audits
Collaborate with team members to resolve discrepancies and implement efficient claims processing practices
Assist in the development of new audit procedures and quality control measures to continuously improve operations
Provide subject matter expertise in medical coding standards, including ICD-10 and CPT codes, to support organizational goals
Contribute to special projects and initiatives as needed to enhance claims auditing and training functions

What we offer

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

Medical Claims Examiner

NTT DATA

Location:
United States , Plano

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 19, 2026

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