TEMP BPO Senior Representative

NTT DATA • Ontario, CA

1d

About The Position

We are currently seeking a TEMP BPO Senior Representative 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed