NTT Data seeks a full time, direct hire Claims Examiner for our customer in Uniontown, OH.
** NTT Data is assisting our healthcare client with the recruiting efforts for this position. This is not a position with NTT DATA.**
GENERAL PURPOSE OF POSITION
It is the responsibility of the Claims Examiner to process medical/dental claims for healthcare services in accordance with Client’s benefit health plan provision.
- Receive incoming calls regarding insurance coverage and benefits, eligibility issues along with claim status.
- Answer and return phone calls and emails from Client members. Return voice mail messages in accordance with organizational standards.
- Accurately process medical / dental claims according to plan provisions, corporate policies and procedures.
- Consistently meet production goals in accordance with organizational standards
- Communicate systems issues promptly to the Claims Supervisor/Manager
- Responsible for the management of all telephone calls and general correspondence received from members of our Client’s health plan
- Demonstrate a positive and cooperative work attitude, encourage teamwork among fellow employees and customers.
- Provide backup in other areas, based on business need, assisting management with special projects or requests.
- Additional tasks as assigned by management.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Additionally, these qualifications are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to serve medical insurance plan members and medical providers by determining insurance coverage including eligibility and claim status; examining and resolving medical claims.
- Must have above average knowledge with claims adjustment / processing, financial software, documentation skills, data entry, analyzing information, problem solving, verbal and written
communication, customer focus, general math skills and statistical analysis.
- Must be able to work independently, be organized and have the ability to multi-task.
- Attendance is crucial to this position.
EDUCATION and/or EXPERIENCE: (Required)
- Associates Degree
- Minimum of three (3) years recent experience in processing medical claims.
- After a one-year training period, expectation is 150 claims paid daily. This percentage is based on industry standards.
- Incoming calls received are taken into account and deducted from daily totals.
- Medical/Dental/Vision – client pays 95% of the monthly premium, employee responsible for the other 5%. – i.e. monthly cost for single employee is $998 – client pays $949 Employee pays $49
- Basic Life (paid by client)
- Voluntary Life – employee paid
- Short & Long Term Disability – employee paid. After 5 years of service, client covers Long Term premium
- Critical Illness/Accident (supplemental policies) – employee paid
- 401(k) option after 1 year of service with up to a 4% of annual salary match by client
- PTO policy – 20 days or 4 weeks accrued for use during first two years of employment. Additional weeks earned with service maxing out at 7 weeks or 35 days of PTO.
- Up to 15 paid holidays per year (in addition to PTO)
- Discount programs
- Employee Assistance Program
*This is not an NTT DATA position. NTT DATA is helping identify the ultimate candidate to present for this open opportunity with our customer hiring direct for a Claims Examiner in Uniontown, OH. However, the info below is related to NTT DATA should you want further information about careers within the company. https://us.nttdata.com/en/careers
Job Type: Full-time
Pay: $33,000.00 – $35,000.00 per year
- What types of claims have you paid? (ie: COB, Medicaid, TPA, vision, dental, self-funded, etc.)
- Have you had to meet production and quality standards in the past? If so, what were they, relative to claims processing and where (what employer)?
- Have you been the person that actually PAID the claims “out the door”, so to speak?
- Associate (Required)
- medical claims processing: 3 years (Required)
- One location
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