Job Details

Claims Examiner - Xcelys Remote, Temporary

NTT DATA Services is 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.