Claims Examiner - Xcelys Remote, Temporary

NTT DATA•Ontario, CA

1d•Remote

About The Position

We are currently seeking a Claims Examiner - Xcelys Remote, Temporary to join our team in Ontario, California (US-CA), United States (US). Senior Claims Examiner (Xcelys System) To serve as a senior-level adjudicator and SME for medical claims within the Xcelys environment. Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.

Requirements

5+ years claims adjudication experience
2 years’ experience in Xcelys or equivalent claims adjudication systems
2 years’ experience (CPT, ICD-10, HCPCS)
1 year experience with system testing and documentation
Deep knowledge of provider contracts, pricing, regulatory guidelines
Excellent analytical and communication skills
Ability to manage high-volume workload and meet performance metrics

Nice To Haves

Experience training staff or acting as a mentor

Responsibilities

Process comprehensive medical claims using Xcelys and associated subsystems
Resolve complex pends, coding issues, and contract exceptions
Author overpayment/underpayment determinations and coordinate appeals
Engage in quality reviews, audits, root cause analyses
Monitor accuracy, variance, and rework metrics
Ensure alignment with regulatory and internal compliance guidelines
Act as escalation point and subject matter expert
Participate in system testing, UAT, and workflow enhancements
Recommend improvements, document system and process changes
Prepare production, pending, and quality reports
Identify trends and recommend corrective actions
Liaise with provider relations, legal, IT, compliance teams
Support internal initiatives related to claims systems / operational improvements