Xcelys Medical Claims Examiner - Remote

Remote Xcelys Medical Claims Examiner

NTT DATA is currently seeking remote Xcelys Medical Claims Examiners with minimum three years of full-cycle, medical claims processing experience and one year of recent Xcelys claims processing experience required. Ability to work Monday–Friday, 8:00 AM–5:00 PM CST.

Summary: 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:

• 5+ 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 Compensation: $20.00/hr

About NTT DATA Services: NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success.