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NTT Group

A global IT innovator founded in 1965, NTT DATA specializes in system integration and networking system services for more than a dozen industries. As an employer, NTT DATA offers a

Claims Examiner - Xcelys

Location

California

Posted

85 days ago

Salary

0

Seniority

Senior

No structured requirement data.

Job Description

Claims Examiner - Xcelys

NTT Group

Title: Claims Examiner - Xcelys Remote, Temporary Location: Ontario, CA, United States Job Description: Req ID: 366967 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 Auditor (Xcelys System) To serve as a Medical Claims Processor within the Xcelys environment. Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations. Role 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 Skills/Experience - 3+ 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 Education: Verifiable high school diploma or GED 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. 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.

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