Claims Adjudication - Associate @ NTT DATA

Job Description

Roles and Responsibilities

• Review & Processes Healthcare payer claims including HCFA & UB forms.
• Validate Member, Provider and other Claims information. 
• Resolve multiple hold codes/edits to complete a transaction.
• Need to verify and understand the health plan documents to take decision on benefits allowed.
• Strong knowledge on all claims type like COB, corrected submission etc.
• Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
• Ensuring accurate and timely completion of transactions to meet or exceed client SLAs 
• Organizing and completing tasks according to assigned priorities.
• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team.
• Resolving complex situations following pre-established guidelines

Desired Candidate Profile

• 1 to 3 years of experience in a BPO handling Healthcare adjudication process in CPS claims platform.
• University degree or equivalent that required 3+ years of formal studies is a must to apply.
• Ability to communicate (oral/written) effectively in English to exchange information with our client.
• 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
• Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM (weekends if required) and to be flexible to accommodate extra hours due to business requirements

Interested candidates please share your resume with pr********************n@nt****a.com

Job Classification

Industry: BPO / Call Centre
Functional Area: BFSI, Investments & Trading,
Role Category: General Insurance
Role: General Insurance
Employement Type: Full time

Education

Under Graduation: Any Graduate
Post Graduation: Any Postgraduate

Contact Details:

Company: NTT Data
Address: Plot No. 7, Oxygen Business Park, Tower F, Sector 144, Noida, Uttar Pradesh 201307
Location(s): Chennai

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Keyskills:   Claims Management claim adjudication Adjudication provider cob claims eob HMO maintenance Claim adjudicator