Job Closed

This listing is no longer active.

NTT Group logo
NTT Group

A global IT innovator founded in 1965, NTT DATA specializes in system integration and networking system services for more than a dozen industries. As an employe

Medical Claims Processor

Location

United States

Posted

100 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Medical Claims Processor

NTT Group

Req ID: 361179 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 Medical Claims Processor to join our team in Plano, Texas (US-TX), United States (US). NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on 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 client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment About NTT DATA NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D. Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us. NTT DATA endeavors to make https://us.nttdata.com 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 https://us.nttdata.com/en/contact-us. 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.

Related Categories

Related Job Pages

More Claims Specialist Jobs

Mercury Insurance logo

Property Claims Specialist Field II

Mercury Insurance

Trusted by customers. Loved by team members. The smarter way to career.

Claims Specialist100 days ago
OtherRemoteTeam 5,001-10,000Since 1962H1B Sponsor

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors. The Property Claims Field Adjuster II will learn to apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate, and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers. Responsibilities - Investigate and resolve Homeowners claims of moderate complexity in a timely and efficient manner. - Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes. - Perform field inspections at least 50% of work time (company car provided). - Handle virtual claims using imagery and advanced video technology to collaborate with onsite vendors and insureds. - Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate. - Establish reserve amounts within prescribed settlement authority limit and negotiate settlement of claims. - Communicate effectively and timely with insureds and/or their representatives to resolve issues and ensure customer satisfaction. - Prioritize responsibilities and manage claims workload to monitor progress and expenses. - Direct, monitor, and review files handled by independent adjusters to conclusion. - Other functions may be assigned. Qualifications - Bachelor’s degree preferred or equivalent combination of education and experience. - Valid driver’s license is required. - Ability to obtain state specific property claims licensing, as required. - Must successfully participate and complete formal property claims training program. - Prior experience using estimating software like Xactimate. - Experience in a related field: property claims experience, customer service environment, construction, restoration, mitigation. - Known for clear and professional communication, both written and verbal. - Bilingual and/or prior military experience is a plus. - 3-5+ years equivalent industry experience is preferred. Knowledge and Skills - Ability to work independently with limited or no supervision. - Passion for outstanding customer service. - Ability to make quality decisions based on analysis, wisdom, experience, and judgment. - Comfortable with and adaptable to new technology and business tools. - Ability to seamlessly transition between various methods of inspection. - Ability to lift and carry up to 50 pounds. - Strong organizational, time management, and prioritization skills. - Willingness to work flexible shifts and overtime as needed. - Drive to and from multiple locations and occasionally outside of normal business hours. Benefits - Competitive compensation. - Flexibility to work from anywhere in the United States for most positions. - Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours). - Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus). - Medical, dental, vision, life, and pet insurance. - 401 (k) retirement savings plan with company match. - Engaging work environment. - Promotional opportunities. - Education assistance. - Professional and personal development opportunities. - Company recognition program. - Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions.

United States
$75.0K - $130.9K / year
Job Closed
OtherRemoteTeam 1,001-5,000Since 1978H1B No Sponsor

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are looking for an experienced Workers’ Compensation Claim Specialist to join our remote team supporting multiple California jurisdiction PEO accounts. In this role, you’ll be trusted to manage your files independently while contributing to a larger team focused on service excellence, compliance, and client partnership. This position offers the stability of dedicated clients, manageable caseloads, and regular collaboration with a team of seasoned WC professionals. A one-week, in-person onboarding and connection session at our Scottsdale office is available to help you integrate seamlessly into the team. Please note: This is not an HR, administrative, consulting, or advisory support role. This is a true adjusting position. Candidates must have proven experience conducting full investigation, evaluation, negotiation, and resolution of workers’ compensation claims, with end-to-end file ownership and decision-making authority. Applicants without direct claims adjusting experience will not be considered. - Investigate, evaluate, and adjust California workers’ compensation claims in compliance with state regulations, CCMSI handling standards, and client instructions. - Establish and maintain accurate reserves and thorough documentation within assigned authority levels. - Review, authorize, and process medical, legal, and indemnity payments. - Negotiate claim settlements aligned with jurisdictional guidelines and industry best practices. - Maintain consistent, professional communication with clients, claimants, attorneys, and providers. - Participate in claim reviews, quality audits, and team discussions to support consistency and compliance. - Deliver excellent client service through timely, detailed, and thoughtful claim handling. Qualifications - Minimum of 10 years of workers’ compensation claim adjusting experience. - Proficiency in Microsoft Office (Word, Excel, Outlook). - Strong written and verbal communication skills. - Proven ability to manage deadlines and multiple priorities effectively. - California jurisdiction experience required. Requirements - California SIP certification (preferred). - Claim review presentation experience (preferred). - AIC, ARM, or CPCU designation (preferred). Benefits - 4 weeks PTO + 10 paid holidays in your first year. - Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance. - Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP). - Career growth: Internal training and advancement opportunities. - Culture: A supportive, team-based work environment.

United States
$85K - $96K / year
Job Closed
CorVel Career Site logo

Claims Assistant

CorVel Career Site

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

Claims Specialist100 days ago

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Claims Assistant will support the claims staff in the set-up and administration of workers’ compensation claims/case management and other tasks depending on the specific customer needs. This role is available for both remote and hybrid work arrangements. Essential Functions & Responsibilities: - Sets up new claims - Process mail, handle files (until paperless), and input notes/diary entries in the claims system - Process payments, as needed - Process form letters, state forms and reports - Assist claims examiners with telephone calls including provider, claimant and customer calls - Additional duties as assigned Qualifications - Excellent written and verbal communication skills - PC literate, including Microsoft Office (Word, Excel) - Ability to work independently and in a team environment - Strong organizational skills Requirements - High school diploma, college degree preferred - Six (6) months of service oriented office experience preferred Benefits - Comprehensive benefits package for full-time regular employees - Medical (HDHP) w/Pharmacy - Dental - Vision - Long Term Disability - Health Savings Account - Flexible Spending Account Options - Life Insurance - Accident Insurance - Critical Illness Insurance - Pre-paid Legal Insurance - Parking and Transit FSA accounts - 401K and ROTH 401K - Paid time off Company Description CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

United States
$13 - $23 / hour
Job Closed
Nationwide Insurance logo

Claims Specialist III, Commercial Casualty

Nationwide Insurance

Nationwide Insurance, founded in 1926, is one of the oldest and most well-respected insurance agencies in the United States. Headquartered in Columbus, Ohio, where more than 10,000

Claims Specialist100 days ago

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Job Description Summary Do you have a strong desire to resolve insurance claims by providing prompt, courteous and fair service to customers? Are you a skilled investigator, negotiator and communicator? If you thrive in an environment where you can problem-solve claims resolution, while following processes that provide fair resolution, customer satisfaction and cost management, then we want to hear from you! As a Claims Specialist, you’ll work to resolve commercial bodily injury and/or property damage claims of a serious and sometimes complex nature. We’ll count on you to promote and provide exemplary customer service. You’ll work to adjust serious exposure commercial casualty claims requiring investigation, property damage evaluation and negotiation. You’ll handle lawsuit files to conclusion and oversee the activities of defense counsel. You’ll also be responsible for handling claims according to prescribed authorization. Job Description Key Responsibilities: - Responsible for assigned claims, which may include complex and catastrophic casualty losses, with little to no direction and oversight. Makes decisions within delegated authority, recommends settlement values in the disposition of claims as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service. - Utilizes various methods of settlement in those cases where warranted; assigns cases to outside vendors as warranted. - Opens, closes and adjusts reserves in alignment with company practices designed to ensure reserve adequacy. Recommends special reserves where necessary, per company guidelines. Adheres to file conferencing notification and authority procedures. - Maintains current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training session - Mentors less experienced claims associates and assists with training/presentations as assigned by claims management. - Partners with Special Investigative Unit (SIU) and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial, or subrogation. (property/MD/casualty). - Oversees defense counsel in all lawsuit activities throughout the life of the claim. - Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers. May perform other responsibilities as assigned. Reporting Relationships: Reports to Claims Manager. Direct and indirect reports not typically assigned. Typical Skills and Experiences: Education: Undergraduate studies in business administration or related field preferred or relevant experience. License/Certification/Designation: Successful completion of required claims certification schools/courses. Professional development such as IIA or CPCU preferred. State licensing where required. Experience: Five years commercial casualty claims handling experience preferred. Knowledge, Abilities and Skills: Proven knowledge of medical, legal and/or commercial claims terminology, state regulations, claims processes, best practices, and customer relationship management. Advanced knowledge of insurance theory and practices, insurance contracts and their application. Excellent customer focus and proven ability to proactively meet customer needs. Analytical skills necessary to make decisions and resolve conflict in application of coverage, laws of jurisdiction to investigation facts, policy exclusions and exceptions. Organizational skills to effectively prioritize increased and more complex workloads. Demonstrates strong standards and flexibility to balance the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with various audiences. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. Knowledge of claims systems. Advanced knowledge of claims best claims practices used to resolve serious and/or high exposure/large loss commercial claims. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Analytical skills used to make independent decisions and resolve conflict. Ability to coordinate with defense counsel in cases involving serious and sometimes complex commercial property damage issues from inception through trial. Command of written and verbal communication skills for contact and/or negotiation. Organizational skills to effectively establish work priorities in accordance with best claims practices. Ability to operate personal computer and related software. Other criteria, including leadership skills, competencies and experiences may take precedence. Staffing exceptions to the above must be approved by the business unit executive and HR Business Partner. Values: Regularly and consistently demonstrates the Nationwide Values. Job Conditions: Overtime Eligibility: Exempt (Not Eligible) Working Conditions: Inside or field claims environment. May require ability to sit and use telephone and personal computer for extended periods of time. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be able to make physical inspections of accident scenes and property loss sites. Must be able to climb ladders, balance at various heights, stoop, bend and/or crawl to inspect vehicles and structures. Must be able to work outside in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. May be on-call. Must be available to work catastrophes (CAT). ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process. We currently anticipate accepting applications until 04/23/2026. However, we encourage early submissions, as the posting may close sooner if a strong candidate slate is identified before the deadline. Benefits We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here. Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law. This position could be filled within any of the lower 48 U.S. states. Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247. For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf NOTE TO EMPLOYMENT AGENCIES: We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means. Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule. The national salary range for Claims Specialist III, Commercial Casualty : $88,000.00-$164,000.00 The expected starting salary range for Claims Specialist III, Commercial Casualty : $88,000.00 - $132,000.00

United States + 1 moreAll locations: United States | Georgia
$88K - $132K / year
Job Closed