About This Role
Reviewing and processing insurance claims is the core responsibility of the Claims Examiner role. This position suits individuals who are detail-oriented and able to navigate complex situations in the healthcare insurance industry.
Responsibilities
- Review and process insurance claims
- Validate member, provider, and other claim information
- Determine accurate payment criteria for clearing pending claims based on defined policy and procedure
- Coordinate claim benefits based on the policy and procedure
- Maintain productivity goals, quality standards, and aging timeframes
- Scrutinize medical claim documents and settlements
- Organize and complete tasks per assigned priorities
- Develop and maintain a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team
- Resolve complex situations following pre-established guidelines
Requirements
- University degree or equivalent that required formal studies of the English language and basic math
- 6+ months of experience applying business rules to varying fact situations and making appropriate decisions
- 6+ months of data entry experience with a focus on quality, including attention to detail, accuracy, and accountability for work product
- 6+ months of experience using a computer with Windows PC applications, requiring keyboard use, screen navigation, and learning new software tools
- 6+ months of experience prioritizing workload to meet deadlines
Nice to have:
- Ability to communicate (oral/written) effectively to exchange information with clients
- Commerce graduate with English as a compulsory subject
Benefits
- Required schedule availability is Monday-Friday (06:00pm to 04:00am IST)
- Shift timings may change as per client requirements
- Overtime and weekend work may be required based on business needs
Important Details
- Schedule: Monday to Friday, 06:00pm to 04:00am IST
Application Process
- Apply with your resume detailing relevant experience
About the Company
NTT DATA Services focuses on delivering quality, integrity, and commitment through its employees, contributing to the company's growth and market presence in the healthcare sector.
