Claims Examiner - Xcelys Remote, Temporary

Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations. 1. Adjudication \u0026 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 Ensure alignment with regulatory and internal compliance guidelines Process \u0026 System Improvement Participate in system testing, UAT, and workflow enhancements Prepare production, pending, and quality reports Support internal initiatives related to claims systems / operational improvements 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 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