NTT DATA Services currently seeks a Medical Claims Auditor to join our team
on a project basis working remote, from home.

Role Responsibilities

• Ensuring all claims transactions are being accurately processed according to plan provisions.
• Performs transactional quality audit based on predefined audit parameters.
• Classify identified errors based on the type of the error, perform root causes for errors, document corrective action plans.
• Perform audit the auditor and detect errors.
• Accurately reporting the accuracy results and metrics
• Facilitates process improvement meetings along with respective teams to achieve the desired results.
• Ability to perform audit and report the findings based on QMS standards and effectively close the non-conformances.
• Ensuring customer satisfaction and striving to meet service standards.
• Collaborating with management or other team members as appropriate to proactively address service issues and concerns.
• Working with claims team on audit findings and resolve questions.

Required Skills:

• An education level of at least a high school diploma or GED
• 2+ years of processing medical claims processing that required a focus on quality including attention to detail, accuracy, and accountability for your work product or the work product of others.
• 2+ years of experience where you had to apply business rules to varying fact situations and make appropriate decisions.
• 1+ years of experience coaching and mentoring others in applying a set of business rules to make decisions.
• 2+ years of experience where you were responsible for collaborating with management or other team members to address service issues and concerns.
• 1+ years of experience in a role where you had to communicate (verbal/written) with internal and external customers to resolve questions and issues.
• 1+ years of documenting or researching written business rules for improving results.
• 2+ years(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.

Preferred Skills:

• 2+ year(s) of experience in the healthcare industry that required member enrollment functions.
• Previous experience applying expertise to improve process quality and efficiency.
• Previous experience with individual and group health plan claims processing.
• Experience in the Diamond Claims Payment system

Job Type: Full-time

Pay: $20.00 per hour

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote

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