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Claims Examiner - Xcelys

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NTT DATA

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Location:
United States , Ontario

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Category:
IT - Administration

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

The Claims Examiner position at NTT DATA requires a minimum of 3 years of claims adjudication experience, including at least 1 year with Xcelys. The role involves processing medical claims, ensuring compliance with regulations, and improving claims workflows. A high school diploma or GED is required. The position is temporary and remote, offering an immediate start. Candidates should possess strong analytical and communication skills, with a focus on quality and compliance. NTT DATA is an equal opportunity employer committed to inclusivity and innovation.

Job Responsibility:

  • Process comprehensive medical claims using Xcelys and associated subsystems
  • Resolve complex pends, coding issues, and contract exceptions
  • Author overpayment/underpayment determinations and coordinate appeals
  • Engage in quality reviews, audits, root cause analyses
  • Monitor accuracy, variance, and rework metrics
  • Ensure alignment with regulatory and internal compliance guidelines
  • Act as escalation point and subject matter expert
  • Participate in system testing, UAT, and workflow enhancements
  • Recommend improvements, document system and process changes
  • Prepare production, pending, and quality reports
  • Identify trends and recommend corrective actions
  • Liaise with provider relations, legal, IT, compliance teams
  • Support internal initiatives related to claims systems / operational improvements

Requirements:

  • 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
  • Verifiable high school diploma or GED

Nice to have:

  • 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

Additional Information:

Job Posted:
May 04, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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