HC & Insurance Operations Processing Sr Rep

About This Role

Process professional claim forms, review policies and benefits, and ensure timely and accurate adjudication of healthcare claims while complying with company regulations and client service level agreements.

Responsibilities

• Process professional claim forms filed by provider
• Review 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
• Sustain and meet the client productivity/quality targets to avoid penalties
• Maintain and sustain quality scores above 98.5% PA and 99.75% FA
• Provide timely response and resolution of claims received via emails as priority work
• Correctly calculate claims payable amount using applicable methodology/fee schedule

Requirements

• 3 years hands-on experience in Healthcare Claims Processing
• 2+ years using a computer with Windows applications, navigating multiple screens and computer systems, and learning new software tools
• High school diploma or GED
• Previously performing in P&Q work environment
• Ability to work from queue remotely
• Keyboard skills and computer familiarity
• Ability to toggle back and forth between screens/navigate multiple systems
• Working knowledge of MS Office products (Outlook, MS Word, MS-Excel)

Qualifications

• High school diploma or GED
• 3+ years hands-on experience in Healthcare Claims Processing

Nice to Have

• Amisys
• Ability to communicate (oral/written) effectively in a professional office setting
• Effective troubleshooting using research, analysis and problem-solving abilities
• Time management with the ability to cope in a complex, changing environment

Skills

* Required skills