Remote Claims Processing Associate Job at NTT DATA (Plano)

Remote Claims Processing Associate

The Remote Claims Processing Associate at NTT DATA is responsible for processing...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems
Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Job Responsibility

Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
Timely response and resolution of claims received via emails as priority work

Remote Claims Processing Associate

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems
Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Job Responsibility

Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
Timely response and resolution of claims received via emails as priority work

Remote Claims Processing Associate

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems
Working knowledge of MS office products – Outlook, MS Word and MS-Excel

Job Responsibility

Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
Timely response and resolution of claims received via emails as priority work

Remote Claims Processing Associate

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems
Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Job Responsibility

Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
Timely response and resolution of claims received via emails as priority work

Senior Claims Processing Associate

The Senior Claims Processing Associate role at NTT DATA involves processing heal...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED
Previously performing – in P&Q work environment
work from queue
remotely
Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems
Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Job Responsibility

Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
Timely response and resolution of claims received via emails as priority work

Analyst- Analytics and Data Science II-III (Remote)

Provide strategic analysis that impacts business decisions, improves efficiency ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

Bachelor's Degree in mathematics, statistics, business, or related field of study
1 year of experience in data analysis using analytic tools and processes (Level 1)
3 years of experience in data analysis using analytic tools and processes (Level 2)
3 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 3)
5 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 4)

Job Responsibility

Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation
Perform data extraction, healthcare cost analysis, analytical model development, as well as production of various reports to support corporate strategies and initiatives
Execute complex analyses that guide the development of reimbursement policy, provider negotiations, network development, value-based care, population health management, utilization management programs and other medical cost containment solutions
Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis in support of multiple strategic goals, mandates, and legislation
Develop processes, write programs and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions
Identify, analyze, interpret and validate healthcare data metrics, trends and patterns
Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies
Model financial impact analyses for a variety of business initiatives
Partner with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards
Act as liaison to both internal business partners and external providers or vendors

Fulltime

New

Bh um clinical reviewer- remote az

Responsible for identifying, researching, processing, resolving and responding t...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in clinical field of practice, health insurance, or other health care related field
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D.
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.

Job Responsibility

Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person
Answer a diverse and high volume of health insurance related customer calls or correspondence daily
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Maintain complete and accurate records per department policy
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Demonstrate ability to apply plan policies and procedures effectively
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
When indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks, Monitor and report team tasks, Communicate team issues and opportunities for improvement to supervisor/manager, Support/mentor team members
Participate in continuing education and current developments in the fields of medicine, behavioral health and managed care at least annually

Fulltime

Business Intelligence Developer-Medicaid - Level I (Remote AZ)

The Business Intelligence Developer - Medicaid role is responsible for the desig...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 years of experience working with data, report development, and analysis in a workplace setting
1 year of experience in query design and effective reporting design structure
High-School Diploma or GED in general field of study
Intermediate proficiency in T-SQL, SSMS, SSRS, SSIS, Visual Studio, SSDT, and Redgate
Intermediate knowledge of Microsoft SQL Server, SQL data bases, table/view/stored procedure development, query tuning, enterprise data modeling, normalizing data, and schema management
Knowledge of decision support systems, business intelligence, programming, and data analysis software
Knowledge of business Intelligence visualization platforms (Qlik Sense, Qlik View, Tableau, Power BI)
Intermediate proficiency in Microsoft Excel, Power Pivot, External connections, DAX/MDX, and Visual Basic
Intermediate proficiency in Microsoft Office Suite (Outlook, Teams, Excel, Word, Access, PowerPoint)
Functional proficiency in requirement analysis and gathering, scoping, and managing projects

Job Responsibility

Meet timeliness and accuracy goals
Use sound project management methodology and demonstrate solid time management skills
Effectively communicate status of work assignments to stakeholders and management via department defined communication channels and policy
Design, develop, or maintain reporting and/or analysis of data to measure financial or clinical outcomes, network performance, care management, claims processing, operations and/or other areas of the business
Design, develop, or maintain reporting and/or analysis of data for medical cost reporting, categories of service, unit cost and financial utilization metrics
Design, develop, or maintain reporting and/or analysis of data for clinical utilization, authorization, care management, risk adjustment, and claims data to support departmental functions
Receives, interprets, and completes data requests from Finance and other departments as necessary
Responsible for technical and production support documentation in accordance with department standards and industry best practices
Adhere to established source control versioning policies and procedures
Participate in all aspects of the Systems Development Life Cycle (SDLC)

Fulltime

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Remote Claims Processing Associate

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