Medical Claims Examiner

NTT DATA North America • Mclean, VA • 6h ago

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 Services currently seeks a Medical Claims Processors to join our team in remotely.

Role Responsibilities

To serve as a Medical Claims Processor within the Xcelys environment , you must have a minimum of 3 yr hands-on, working experience within its environment . You should also 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

Verifiable high school diploma or GED

Must be able to work 8am-5pm PST

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. Visit nttdata.com or LinkedIn to learn more.

NTT DATA Services 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 . 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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