[Hiring] Senior Medical Claims Examiner @The Nippon Telegraph and Telephone Corporation (NTT)

Role Description

NTT DATA Services currently seeks Xcelys Medical Claims Examiners to join our team remotely for a 6-18 month contract role.

To serve as a Medical Claims Processor within the Xcelys managed care software platform 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

Qualifications

• 3-5+ 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

Requirements

• Must have XCELYS SYSTEM EXPERIENCE
• MINIMUM 3 YEARS CLAIMS EXPERIENCE
• Open to work Central Time and PST
• 3-4 WEEK TRAINING PERIOD
• Must be US based
• $20.00 hour W2

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