TEMP BPO Senior Representative
NTT DATA North America, Eden Prairie, MN, United States
Req ID:
365071
NTT DATA strives to hire exceptional, innovative, and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
We are currently seeking a TEMP BPO Senior Representative to join our team in Eden Prairie, Minnesota (US-MN), United States (US).
Senior Claims Examiner (Xcelys System) 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.
Key Duties & 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 / Preferred Skills & Experience
5+ years claims adjudication experience
2 years’ experience in Xcelys or equivalent claims adjudication systems
2 years’ experience (CPT, ICD-10, HCPCS)
1 year experience with system testing and documentation
Deep knowledge of provider contracts, pricing, regulatory guidelines
Excellent analytical and communication skills
Experience training staff or acting as a mentor
Ability to manage high-volume workload and meet performance metrics
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
NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For Pay Transparency information, please click here.
#J-18808-Ljbffr
365071
NTT DATA strives to hire exceptional, innovative, and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
We are currently seeking a TEMP BPO Senior Representative to join our team in Eden Prairie, Minnesota (US-MN), United States (US).
Senior Claims Examiner (Xcelys System) 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.
Key Duties & 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 / Preferred Skills & Experience
5+ years claims adjudication experience
2 years’ experience in Xcelys or equivalent claims adjudication systems
2 years’ experience (CPT, ICD-10, HCPCS)
1 year experience with system testing and documentation
Deep knowledge of provider contracts, pricing, regulatory guidelines
Excellent analytical and communication skills
Experience training staff or acting as a mentor
Ability to manage high-volume workload and meet performance metrics
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
NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For Pay Transparency information, please click here.
#J-18808-Ljbffr