Req ID: 365465 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). Senior Claims Examiner (Xcelys System) 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 / 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 contracts, 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 rate - Turnaround time for pends / escalations - Contribution to system / process enhancements - Feedback from peer and leadership reviews About NTT DATA NTT DATA 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-scale AI, cloud, security, 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. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D. Whenever possible, we hire locally to NTT DATA 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 NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA 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. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all 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. NTT 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. 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.

Req ID: 365464 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). Senior Claims Examiner (Xcelys System) 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 / 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 contracts, 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 rate - Turnaround time for pends / escalations - Contribution to system / process enhancements - Feedback from peer and leadership reviews About NTT DATA NTT DATA 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-scale AI, cloud, security, 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. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D. Whenever possible, we hire locally to NTT DATA 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 NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA 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. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all 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. NTT 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. 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.

Req ID: 365467 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). Senior Claims Examiner (Xcelys System) 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 / 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 contracts, 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 rate - Turnaround time for pends / escalations - Contribution to system / process enhancements - Feedback from peer and leadership reviews About NTT DATA NTT DATA 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-scale AI, cloud, security, 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. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D. Whenever possible, we hire locally to NTT DATA 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 NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA 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. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all 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. NTT 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. 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.

The WC Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: - Receives Workers’ Compensation claim, confirms policy coverage and acknowledgement of the claim - Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies - Establishes reserves and authorizes payments within reserving authority limits - Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim - Coordinates early return-to-work efforts with the appropriate parties - Manages subrogation and litigation of claim as it applies - Manages potential claim recoveries of all types - Reports claims to the excess carrier when applicable - Communicates claim status with the customer and claimant - Adheres to client and carrier guidelines and participates in claims review as needed - Develops and maintains professional customer relationships - Complies with rules and regulations of applicable state - Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”) - Additional duties as assigned KNOWLEDGE & SKILLS: - Excellent written and verbal communication skills - Ability to assist team members to develop knowledge and understanding of claims practice - Ability to identify, analyze and solve problems - Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets - Strong interpersonal, time management and organizational skills - Ability to work both independently and within a team environment - Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation EDUCATION & EXPERIENCE: - Bachelor's degree or a combination of education and related experience - Minimum of 3 years’ industry experience and claim handling - Self-Insured Certificate preferred - State Certification or license as an experienced claims adjuster - Current license or certification in Workers’ Compensation must be maintained throughout employment with CorVel PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $29.35 - $47.28 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote