- Reviews, research, and make necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction.
- Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) to process both coordinated and non-coordinated claims correctly. Requesting medical records may be required.
- Communicates, both orally and in writing, with internal and external contacts to provide necessary and accurate information for the establishment of sound claims records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc.
- Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.
- Research, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to ***
- Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews of all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability.
- Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability.
- Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation). May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction.
- 2 years in medical claims processing required
• Coordination of Benefits (COB) processing experience preferred - Strong analytical ability, that includes strong logical, systemic, and investigates thinking.
- Strong oral and written communication skills and human relations skills are necessary.
- Working knowledge of relevant PC software.
- Ability to prioritize multiple streams of work effectively.
- High School Diploma or equivalent required Work Experience
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Healthcare Claims Specialist - Tampa - NTT DATA
Description
Company Overview:Req ID: 360808
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
We are currently seeking a Claims Specialist to join our team and REMOTE. The position is for 6 months and pay rate is $19.25/hour W2
Job Description:
Claims Specialist
Job Description
The claims Specialist will Identify primary vs. secondary coverage when a member has more than one health plan. Reviewing and updating claims to reflect correct COB rules Applying COB primacy rules (subscriber status, effective dates, plan type, Medicare coordination, etc.) Communicating with members, providers, and other insurers to verify coverage details Correcting overpayments, initiating refunds or reprocessing, and maintaining accurate claim records Working within claims systems and following regulatory and compliance requirements (e.g., HIPAA)
Job Duties
Duties may include the following responsibilities or functions required to support the claims unit.
NTT DATA 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 innovate, optimize and transform for long term success. 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 artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at
NTT DATA endeavors to make accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $19.25/hour. This range reflects the minimum and maximum target compensation for the position across all 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 may also be eligible for incentive compensation based on individual and/or company performance.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.
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