What are the responsibilities and job description for the TEMP BPO Senior Representative position at NTT DATA Americas, Inc.?
Req ID: 366968
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 Ontario, California (US-CA), United States (US).
Senior Claims Auditor (Xcelys System)
To serve as a Medical Claims Processor within the Xcelys 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
Required Skills/Experience
- 3 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
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: Verifiable high school diploma or GED
About NTT DATA
NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.
Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.
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