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Senior Claims Examiner (Xcelys System)

NTT DATA Services currently seeks a Senior Claims Examiner to join our team working 100% Remote and work on the PST hours of 8 am – 5 pm. This is a temporary role 3 months with a mandatory 2-4 week training on camera.

Job Description

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.

Key Duties & Responsibilities

-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

-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 Qualifications and skills:

-5+ years claims adjudication experience

-1+ year experience in Xcelys or equivalent claims adjudication systems

-1 year of expertise in coding (CPT, ICD-10, HCPCS)

Preferred Qualifications:

-Deep knowledge of provider contracts, pricing, regulatory guidelines

-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

-Success Measures / KPIs

-Claims processed per day / throughput

-Accuracy / audit scores

-Rework / error rate

-Turnaround time for pends / escalations

-Contribution to system / process enhancements

-Feedback from peer and leadership reviews

About NTT Data :

NTT DATA is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.

NTT DATA 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 **$20-21/hour** . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.