Medical Claims Processor - Remote

NTT DATA is a $30+ billion trusted global innovator of business and technology services. It serves 75% of the Fortune Global 100 and invests over $3.6 billion each year in R&D to help organizations move confidently into the digital future.

NTT DATA is seeking a Medical Claims Processor for a remote position in Plano, TX (US‑based W‑2). All candidates will be paid through NTT DATA only.

• Process professional claim form files from providers.
• Review policies and benefits for accuracy.
• Comply with HIPAA, confidentiality, and PHI regulations.
• Complete required compliance training within the specified timelines.
• Research, review, and act on claims independently.
• Prioritize work and adjudicate claims according to turnaround time and SLAs.
• Adhere to client‑defined workflows and guidelines for claim adjudication.
• Maintain and meet client productivity/quality targets to avoid penalties.
• Maintain quality scores above 98.5% PA and 99.75% FA.
• Respond promptly and resolve claims received via email as a priority.
• Correctly calculate claim payable amounts using the applicable methodology and fee schedule.
• Leverage research, analysis, and problem‑solving skills for effective troubleshooting.
• Manage time effectively in a complex, changing environment.
• Communicate orally and in writing in a professional office setting.

• 1+ year(s) hands‑on experience in Healthcare Claims Processing.
• Previously performed P&Q work in a queue environment; remote experience preferred.
• 2+ years using Windows applications; proficient at navigating multiple screens and learning new software tools.
• Keyboard and computer familiarity, including toggling between screens/systems.
• Working knowledge of MS Office products – Outlook, Word, and especially Excel.

• Experience with Amisys and/or Xcelys is preferred.

The starting hourly range for this remote role is $18.00/hourly
. Actual compensation will depend on location, experience, and other qualifications.

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; 401(k) program with company match; and additional voluntary or legally required benefits.

NTT DATA is an equal opportunity employer and considers all applicants without regard to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, disability, veteran status, or marital status. If you need assistance or an accommodation due to a disability, please inform your recruiter.

• Seniority level:
  Not Applicable
• Employment type:
  
  Other
• Job function:
  Health Care Provider
• Industries: IT Services and IT Consulting