Luminex Claims Examiner
Company: NTT DATA
Posted on: September 22, 2022
NTT Data seeks a full time, -direct hire -Luminex -Claims
Examiner/Plan Builder for our customer in Missoula, MT to work
onsite or -REMOTE.** NTT Data is assisting our healthcare client
with the recruiting efforts for this position. This is not a
position with NTT DATA.**POSITION RESPONSIBILITIES:The Plan Builder
is responsible for the creation, maintenance, and improvement of
plan benefit set-ups in the software system used to process and pay
medical, dental, vision, and disability claims. The incumbent is
also responsible for setting up PPO benefits and coordinating the
maintenance of PPO providers with the individual(s) maintaining the
provider records and back-up maintenance of the IVR system.The
incumbent is expected to communicate professionally with peers,
supervisors, subordinates, vendors, customers, and the public, and
to be respectful and courteous in the conduct of this
position.ESSENTIAL JOB FUNCTIONS:Essential job functions include
the following. Other functions may be assigned as business
- Creates new plan benefit set-ups by reviewing and interpreting
the plan document supplied as the plan benefits for the new
- Works with marketing and legal department personnel to
determine the system capability of proposed new benefits or plan
- Maintains existing plan benefit set-ups based on amendments or
new plan documents for existing groups.
- Creates PPO set-ups based on the plan document for new
- Maintains PPO plan benefit set-ups based on amendments or new
plan documents for existing groups.
- Creates, maintains and improves PPO plan benefit set-ups.
- Maintains knowledge of the claims processing software and
researches methods of improving the processing of claims utilizing
- Maintains PPO set-ups in group master files.
- Creates and maintains PPO repricing logic within the
- Coordinates PPO maintenance and provides assistance with PPO
maintenance to the individual(s) maintaining provider records in
- Investigates problems as represented by claims examiners or
auditors; identifies problems and codes corrections within the
- Complies with all privacy and confidentiality laws in the
course of business.
- Supports the IVR Maintenance Specialist by handling back-up
responsibilities for the IVR system.
- Contributes to the daily workflow with regular and punctual
attendance.NON-ESSENTIAL JOB FUNCTIONS:
- Coordinates plan benefit problems with the Plan Building
Supervisor and/or the Claims Department Manager.
- Assists with provider/PPO maintenance.
- Performs related or other assigned duties as required or
directed.PHYSICAL WORKING CONDITIONS:Physical requirements are
representative of those that must be met to successfully perform
the essential functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the
essential functions.Sitting 90% Reaching Some Standing 5% Manual
Dexterity High Walking 5% Telephone Yes Kneeling Some Computer
Screen High (visual acuity corrected to 20/30) Bending Some Lifting
up to 20 lbs.JOB SPECIFICATIONS:To perform this job successfully,
an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of
the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.
- Minimum Education: High school graduation or GED required.
College degree and/or training in medical terminology and health
- Completion of a minimum of three HIAA and/or ICA courses. An
undergraduate degree will be accepted as a waiver of this
requirement to obtain the position, but successful completion of
these courses will be required to remain in the position.
- Minimum Experience: One year of experience in the health
insurance industry is required in the absence of an undergraduate
degree. Formal training in computer programming or an aptitude for
converting plan language into programming language is
- Excellent oral and written communication skills required.
- PC skills, including Windows and Word. Must be able to adapt to
software changes as they occur.
- Thorough understanding of claims processing procedures and
- Ability to think creatively to produce solutions to claims
- Ability to create the most efficient method possible for
- Ability to be trained to understand and produce computer
programming code in the software system required language.
- Typing ability of 40 wpm net.
- Knowledge of medical terminology and basic health insurance
- Excellent listening skills.
- Basic mathematical skills.
- High level of interpersonal skills to work effectively with
- Ability to organize and recall large amounts of detailed
- Ability to read, analyze and interpret benefit summary plan
descriptions, insurance documents and regulations. Ability to
convert that understanding into the system required coding
necessary to pay benefits.
- Ability to project a professional image and positive attitude
in any work environment.
- Ability to comply with confidentiality and privacy
- Ability to be flexible, work under pressure and meet
- Ability to analyze and solve problems with professionalism and
- Ability to prioritize problems and responsibilities.
- Ability to operate typical office equipment.
- Working knowledge of general office procedures.*This is not an
NTT DATA position. NTT DATA is helping identify the ultimate
candidate to present for this open opportunity with our customer
hiring direct for a Luminex Claims Examiner/Plan Builder in
Missoula, MT onsite or REMOTE. However, the info below is related
to NTT DATA should you want further information about careers
within the company. https://us.nttdata.com/en/careers
Keywords: NTT DATA, Billings , Luminex Claims Examiner, Other , Wilsall, Montana
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