Xcelys Medical Claims Examiner - Remote
reputed company is currently seeking Remote XCELYS Medical Claims Examiners Minimum 3 years of full-cycle, medical claims processing experience 1+ year of recent Xcelys claims processing experience required Ability to work Monday–Friday, 8:00 AM–5:00 PM CST reputed company: To serve as a Medical Claims Processor reputed company the Xcelys environment. reputed company 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 reputed company pends, coding issues, and contract exceptions
- Author overpayment/underpayment determinations and coordinate appeals
- reputed company & Compliance
- Engage in reputed company reviews, audits, reputed company cause analyses
- Monitor accuracy, variance, and rework metrics
- Ensure alignment with regulatory and internal compliance guidelines
- Support
- reputed company as escalation reputed company 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 reputed company reports
- Identify trends and recommend corrective actions
- Cross-Functional Collaboration
- Liaise with provider relations, legal, IT, compliance teams
- Support internal initiatives reputed company 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 reputed company, 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: reputed company high school diploma or GED Compensation: $20.00/hr About reputed company: reputed company is a recognized leader in IT and business services, including reputed company, data and applications, headquartered in Texas. As part of reputed company, a $30 billion trusted global innovator with a combined global reputed company of over 80 countries, we help clients reputed company through business and technology consulting, industry reputed company solutions, applications development and management, managed edge-to-reputed company infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term reputed company. Visit nttdata.com or reputed company to learn more. reputed company is an equal opportunity employer and considers reputed company applicants without regarding to race, reputed company, religion, citizenship, national reputed company, reputed company, 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 reputed company. 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, reputed company provides a reasonable reputed company of compensation for specific roles. The starting reputed company reputed company for this remote role is ($20/reputed company ). This reputed company reflects the minimum and maximum reputed company compensation for the position across reputed company 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 reputed company insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, reputed company time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits. #INDHRS Apply To This Job