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Xcelys Medical Claims Examiner-REMOTE

NTT DATA

Ontario, CA(remote)

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JOB DETAILS
SALARY
SKILLS
Acceptance Testing, Adjudication, Analysis Skills, Claims Processing, Communication Skills, Corrective Action, Cross-Functional, Current Procedural Terminology (CPT), Documentation, Genetics, Healthcare Common Procedure Coding System (HCPCS), ICD-10, Legal, Mentoring, Metrics, Operational Improvement, Performance Metrics, Pricing, Process Improvement, Provider Contracting, Provider Relations, Regulations, Regulatory Compliance, Root Cause Analysis, Staff Training, System Operations, System Test, Trend Analysis, Writing Skills
LOCATION
Ontario, CA(remote)
POSTED
2 days ago
At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

NTT DATA Services currently seeks Xcelys Medical Claims Examiners to join our team remotely for a 6-12 month contract role.

MUST HAVE XCELYS EXPERIENCE

To serve as a Medical Claims Processor within the Xcelys environment. Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.

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

Required Skills/Experience  
  • 5+ years claims adjudication experience
  • Minimum of 1 year experience in Xcelys 
  • 2+ years in coding (CPT, ICD-10, HCPCS)
  • 2+ years provider contracts, pricing, regulatory guidelines experience
Preferences
  • Excellent analytical and communication skills
  • Experience training staff or acting as a mentor
  • Familiarity with system testing and documentation
  • Ability to manage high-volume workload and meet performance metrics
Education: Verifiable high school diploma or GED

About NTT DATA Services:

NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is ($20/hourly ). This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.
 

About the Company

N

NTT DATA

NTT DATA means Business

NTT DATA is your Innovation Partner anywhere around the world. With business operations in more than 50 countries, we put emphasis on long-term commitment and combine global reach and local intimacy to provide premier professional services from consulting, system development, business process and IT outsourcing, to cloud-based solutions.

NTT DATA Americas' Strategic Staffing group provides our clients with top notch technical talent to augment their core IT staff. Our approach is customer centric, partnering to assist you in achieving your strategic goals and IT initiatives. We get to know your company’s culture and the type of technical staff that thrive within your organization. We understand your specific technical and business requirements, timing, and budget.

  • NTT DATA is part of the NTT Group – a Fortune 31 Global IT & Telecom services company.
  • NTT Group one of the largest Telecommunications Companies in the world.
  • NTT DATA is ranked in the top 10 largest global IT services provider in the world.
Collectively, the integrated company generates $16B in annual revenues with over 130,000 employees across 50 countries Visit www.nttdata.com/americas to learn how our consultants, projects, managed services, and outsourcing engagements deliver value for a range of businesses and government agencies.

COMPANY SIZE
10,000 employees or more
INDUSTRY
Management Consulting Services
EMPLOYEE BENEFITS
Retirement / Pension Plans
FOUNDED
1967
WEBSITE
http://americas.nttdata.com/Careers/Careers.aspx

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