Claims Examiner - Xcelys Remote, Temporary

NTT DATA 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 forward"‘thinking organization, apply now.We are currently seeking a Claims Examiner - Xcelys Remote, Temporary to join our team in Ontario, California (US"‘CA), United States (US).As a senior"‘level adjudicator and SME for medical claims within the Xcelys environment, you will provide subject"‘matter expertise on claims workflows and serve as a key contributor to system enhancements, audits, and process optimizations.Key Duties & ResponsibilitiesAdjudication & ReviewProcess comprehensive medical claims using Xcelys and associated subsystemsResolve complex pends, coding issues, and contract exceptionsAuthor overpayment/underpayment determinations and coordinate appealsQuality & ComplianceEngage in quality reviews, audits, root cause analysesMonitor accuracy, variance, and rework metricsEnsure alignment with regulatory and internal compliance guidelinesSupportAct as escalation point and subject matter expertProcess & System ImprovementParticipate in system testing, UAT, and workflow enhancementsRecommend improvements, document system and process changesReporting & AnalyticsPrepare production, pending, and quality reportsIdentify trends and recommend corrective actionsCross"‘Functional CollaborationLiaise with provider relations, legal, IT, compliance teamsSupport internal initiatives related to claims systems / operational improvementsRequired / Preferred Skills & Experience5+ years claims adjudication experience2 years' experience in Xcelys or equivalent claims adjudication systems2 years' experience (CPT, ICD"‘10, HCPCS)1 year experience with system testing and documentationDeep knowledge of provider contracts, pricing, regulatory guidelinesExcellent analytical and communication skillsExperience training staff or acting as a mentorAbility to manage high"‘volume workload and meet performance metricsSuccess Measures / KPIsClaims processed per day / throughputAccuracy / audit scoresTurnaround time for pends / escalationsContribution to system / process enhancementsFeedback from peer and leadership reviewsNTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. #J-18808-Ljbffr

Created: 2026-04-20