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

Req ID: 365465 

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

We are currently seeking a Claims Examiner - Xcelys Remote, Temporary to join reputed company in Ontario, California (US-CA), reputed company (US).

Senior Claims Examiner (Xcelys System)

To serve as a senior-level adjudicator and SME for medical claims reputed company the Xcelys environment. reputed company 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
• reputed company & Compliance
• Engage in reputed company reviews, audits, reputed company cause analyses
• Monitor accuracy, variance, and rework metrics
• Ensure alignment with regulatory and internal compliance guidelines
• Support
• reputed company 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 reputed company reports
• Identify trends and recommend corrective actions
• Cross-Functional Collaboration
• Liaise with provider relations, reputed company, 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

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

Whenever possible, we hire locally to reputed company offices or reputed company sites. This ensures we can reputed company reputed company and effective support tailored to reputed company reputed company’s needs. While many positions offer remote or hybrid work reputed company, these arrangements are subject to change based on reputed company requirements. For employees near an reputed company office or reputed company 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 reputed company payment or disclose banking information, please submit a contact us reputed company, 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. reputed company applicants will receive consideration for employment without reputed company to race, reputed company, 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.