Sr. Medical Claims Examiners (3+ years of Xcelys required)

NTT DATA is currently seeking Senior Medical Claims Examiners (3+ years of Xcelys required) to join our U.S. based team.  This is a 100% remote role.
 

Purpose 
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.
 
Responsibilities

• 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

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

Required:

• 5+ years claims adjudication experience
• 3+ years of experience in Xcelys claims adjudication systems
• Expertise in coding (CPT, ICD-10, HCPCS)
• Deep knowledge of provider contracts, pricing, regulatory guidelines
• 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

About NTT DATA:

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
 
For more than 25 years, NTT DATA Services have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

NTT DATA  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. Visit nttdata.com or LinkedIn to learn more.

NTT DATA  is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $20.00 - $21.00/hourly. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

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