Xcelys Medical Claims Examiner

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.

NTT DATA Services currently seeks Xcelys Medical Claims Examiners to join our team remotely for a 3 month contract role.

MUST HAVE XCELYS EXPERIENCE

Role Responsibilities:

• Adjudication & Review
• Process comprehensive medical claims using Xcelys and associated subsystems
• Resolve complex pends, coding issues, and contract exceptions
• Author over payment/underpayment determinations and coordinate appeals

• Quality & Compliance
• Engage in quality reviews, audits, root cause analyses
• Monitor accuracy, variance, and rework metrics
• Ensure alignment with regulatory and internal compliance guidelines

• Support
• Act as escalation point and subject matter expert

• Process & System Improvement
• Participate in system testing, UAT, and workflow enhancements
• Recommend improvements, document system and process changes

• Reporting & Analytics
• Prepare production, pending, and quality reports
• Identify trends and recommend corrective actions

• 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

Hours:

Must be able to work 8am-5pm PST

Education:

Verifiable high school diploma or GED

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.

The starting hourly range for this remote role is ($20 - $21/hourly ).

This position is eligible for company benefits that will depend on the nature of the role offered.