Claims Examiner - Xcelys Remote, Temporary
NTT DATA•Ontario, CA
•Remote
About The Position
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
