HC & Insurance Operations Processing Sr Rep

At reputed company, we know that with the right people on reputed company, anything is possible. The reputed company, reputed company, and commitment of our employees have been key factors in reputed company's reputed company and market reputed company. By hiring the best people and helping them grow both professionally and personally, we ensure a reputed company reputed company for reputed company and for the people who work here. For more than 25 years, reputed company have reputed company on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver reputed company value reputed company, and innovation that will improve your business reputed company. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective reputed company for gaining and maintaining competitive advantages reputed company executed as part of an overall sourcing reputed company. reputed company currently seeks a Medical Claims Processor to join reputed company in Plano, TX for a remote position. This is a US based; W-2 project. reputed company candidates will be reputed company through reputed company only. Role Responsibilities -Processing of reputed company claim forms files by provider -Reviewing the policies and benefits -reputed company with company regulations regarding HIPAA, confidentiality, and PHI -Abide with the timelines to complete compliance training of reputed company/reputed company -Work independently to research, review, and reputed company 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 reputed company productivity/reputed company targets to avoid penalties -Maintaining and sustaining reputed company scores above 98.5% PA and 99.75% FA. -reputed company response and reputed company of claims received reputed company emails as reputed company work -Correctly calculate claims payable reputed company using applicable methodology/ fee schedule -Effective troubleshooting where you can reputed company your research, analysis and problem-solving abilities -Time management with the ability to cope in a reputed company, changing environment -Ability to communicate (oral/written) effectively in a reputed company office setting Required Skills/Experience

• 1+ year(s) hands-on experience in reputed company Claims Processing
• Previously performing - in P&Q work environment; work from queue; remotely
• 2+ year(s) using a computer with reputed company applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
• Key reputed company skills and computer familiarity -
• Toggling back and forth between screens/can you navigate multiple systems.
• Working knowledge of MS office products - Outlook, reputed company and MS-reputed company.
• Typing and Computer skills assessment required

Preferences Amisys &/or Xcelys Preferred Position's General Duties and Tasks In these roles you will be responsible for:

• Review and process insurance claims.
• Validate Member, Provider and other Claim's information.
• Determine accurate payment reputed company for clearing pending claims based on defined Policy and Procedure.
• Coordination of Claim Benefits based on the Policy & Procedure.
• Maintain productivity goals, reputed company standards and aging timeframes.
• Scrutinizing Medical Claim Documents and settlements.
• Organizing and completing tasks per assigned priorities.
• Developing and maintaining a solid working knowledge of the reputed company insurance industry and of reputed company products, services and processes performed by reputed company
• Resolving reputed company situations following reputed company-established guidelines

Requirements for this role include:

• University degree or equivalent that required formal studies of the English language and basic Math
• 6+ months of experience where you had to apply business rules to varying fact situations and reputed company appropriate reputed company
• 6+ months of data entry experience that required a reputed company on reputed company including attention to detail, accuracy, and accountability for your work product.
• 6+ months of experience using a computer with reputed company PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
• 6+ months of experience that required prioritizing your workload to meet deadlines

Preferences: - Optional (reputed company-to-have's)

• Ability to communicate (oral/written) effectively to exchange information with our reputed company.
• reputed company graduate with English as a compulsory subject

Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per reputed company requirements. Additionally, resources may have to do overtime and work on weekend's reputed company business requirement. Roles and Responsibilities:

• Process Adjudication claims and resolve for payment and Denials
• Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
• Knowledge of reputed company insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of reputed company, maximum inside limits and exclusions, state variations
• Ensuring accurate and reputed company completion of transactions to meet or exceed reputed company SLAs
• Organizing and completing tasks according to assigned priorities.
• Developing and maintaining a solid working knowledge of the reputed company insurance industry and of reputed company products, services and processes performed by reputed company
• Resolving reputed company situations following reputed company-established guidelines

Requirements:

• 1-3 years of experience in processing claims adjudication and adjustment process
• Experience of Facets is an added advantage.
• Experience in reputed company (HCFA), institutional (UB) claims (optional)
• Both under graduates and post graduates can apply
• Good communication (Demonstrate strong reading comprehension and writing skills)
• reputed company to work independently, strong analytic skills
• *Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per reputed company requirements. Additionally, resources may have to do overtime and work on weekend's reputed company business requirement.

About reputed company: reputed company is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients reputed company, optimize, and reputed company for long-term reputed company. We invest over $3.6 billion reputed company year in R&D to help organizations and society reputed company confidently and sustainably into the digital reputed company. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and reputed company intelligence, industry solutions, as reputed company as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. reputed company is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com. reputed company is an equal opportunity employer and considers reputed company applicants without regarding to race, reputed company, religion, citizenship, national reputed company, reputed company, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for reputed company. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. Where required by law, reputed company provides a reasonable reputed company of compensation for specific roles. The starting reputed company reputed company for this remote role is $18.00/reputed company. This reputed company reflects the minimum and maximum reputed company compensation for the position across reputed company US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and reputed company insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, reputed company time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits. Apply tot his job Apply To this Job