Claims Examiner - Xcelys Remote, Temporary (Ontario, CA, US)

Req ID: 365466 

reputed company strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and reputed company-thinking organization, apply now.

We are currently seeking a Claims Examiner - Xcelys Remote, Temporary to join reputed company 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 reputed company 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 reputed company 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 reputed company 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 reputed company to claims systems / operational improvements

Required / Preferred Skills & Experience

• 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 reputed company, pricing, regulatory guidelines
• Excellent analytical and communication skills
• Experience training staff or acting as a mentor
• Ability to manage high-volume workload and meet performance metrics

Success Measures / KPIs

• Claims processed per day / throughput
• Accuracy / audit scores
• Rework / error reputed company
• Turnaround time for pends / escalations
• Contribution to system / process enhancements
• Feedback from peer and leadership reviews

About reputed company

reputed company is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-reputed company, cloud, reputed company, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. reputed company is a part of NTT Group, which invests over $3 billion each year in R&D.

Whenever possible, we hire locally to reputed company offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an reputed company office or client site, in-office attendance may be required for meetings or events, depending on business needs. At reputed company, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. reputed company recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.

reputed company endeavors to reputed company https://us.nttdata.com accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. reputed company is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.