Claims Examiner

NTT Data Corporation Miami , FL 33196

Posted 6 months ago

Req ID: 60505

At NTT DATA Services, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA Services and for the people who work here.

NTT DATA Services currently seeks a Claims Examiner to join our team in Miami, Florida (US-FL), United States (US).

Responsibilities

  • Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.

  • Accurately recognizes and reports trends or issues identified from daily work and works in partnership with leadership to develop and implement solutions.

  • Consistently meets departmental production standards

  • Consistently meets departmental quality standards

  • Demonstrates strong knowledge of claims processing, ensures claims and associated holds impacted by other insurance are properly researched and resolved in a timely fashion. Recognizes and takes action to ensure timely reprocessing of claim(s).

  • Identifies updates required to external systems, state or federal, and takes action to ensure the appropriate and accurate update is made in a timely manner. Reviews and works any submission rejection in a timely manner and consistently meets departmental goals related to submission acceptance.

  • Identify areas of opportunity to improve service to members and/or reduce member impact. Initiate outreach efforts, to members, other carriers, or clients, when deemed appropriate or necessary to gather necessary information to resolve issues or appropriate resolve case..

  • Interface with internal and external customers to assure resolution of inquiries and concerns. Access, investigate, and resolve issues to achieve customer satisfaction, seeking to achieve one touch resolution with all departmental requests for assistance. .

  • Investigates all possible instances of other insurance for all lines of business appropriately and accurately utilizing internal and external systems to verify existence of other insurance. Appropriately and accurately applies NAIC, Medicare, and other state and/or federal regulations to determine proper order of benefits.

  • Processes member requests to update other insurance coverage, including from surveys, phone calls, custody court order requests, or other member correspondence. Ensures request is fully processed, documented, and resolved.

  • Properly updates member record to reflect primary or secondary coverage based on findings. Ensures documentation is accurate, clear, and thorough.

  • Provides support with departmental mailboxes, web requests, and/or chats. Consistently demonstrates courteousness and professionalism with internal and external customers. Anticipates and addresses additional questions and concerns.

Qualifications

  • High school diploma or equivalent required.

  • 6+ months of customer service experience and or other business environment.

  • Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.

  • Strong organizational, interpersonal, and communication skills.

  • Attention to detail is critical to the success of this position, with skills in customer orientation.

  • Will need to manage multiple tasks and projects.

  • Strong analytical skills required. MS Office/PC skills required.

  • 6+ months of claims adjustment experience with coordination of benefits required.

This position is only available to those interested in direct staff employment opportunities with NTT DATA, Inc. or its subsidiaries. Please note, 1099 or corp-2-corp contractors or the equivalent will NOT be considered. We offer a full comprehensive benefits package that starts from your first day of employment.

About NTT DATA Services

NTT DATA Services partners with clients to navigate and simplify the modern complexities of business and technology, delivering the insights, solutions and outcomes that matter most. We deliver tangible business results by combining deep industry expertise with applied innovations in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services.

NTT DATA Services, headquartered in Plano, Texas, is a division of NTT DATA Corporation, a top 10 global business and IT services provider with 118,000+ professionals in more than 50 countries, and NTT Group, a partner to 88 percent of the Fortune 100. Visit nttdataservices.com to learn more.

NTT DATA, Inc. (the "Company") is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.


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Claims Examiner

NTT Data Corporation