EXL

Analyzes business data and runs outsourced operations

Senior Executive - Claims Audit

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeChennai, Tamil Nadu, IndiaNo salary listed

About the Job

Requirements

A graduate or postgraduate qualification in any field.
Three to five years of experience.
Knowledge of Microsoft Outlook, Excel, Word, and PowerPoint.
Strong analytical skills and the ability to investigate and resolve issues.
Familiarity with HIPAA, Medicare, Medicaid, and other payer-specific regulations.
Good communication, flexibility, and reliability.

Responsibilities

Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
Verify that necessary clinical documentation is included to support claim submissions and medical necessity.
Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
Prioritize and manage workloads so expedited and high-priority cases are processed within defined timelines.
Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, and HCPCS), and insurance claim procedures.
Complete the necessary training and meet the expectations outlined for the position.
Follow all standard operating procedures diligently.
Complete audits promptly and ensure high quality.
Strive to meet quality and production targets.
Adhere to project protocols and instructions.
Report issues or trends promptly.
Keep logs, such as productivity and clarification logs, updated as applicable.
Seek clarification from the manager or team leader when needed.
Respond promptly to emails from the manager.
Ensure compliance with all relevant regulations and policies.

Job description:

Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.

Qualifications: Any Graduate/ Postgraduate

Working Hours: 40 hours /week, Full Time Employee

Work Model: Training from office for 2 - months and hybrid there after

Telecommuter/Internet requirements, if applicable: High Speed internet connection and Power back up

Skills and abilities:

3-5 years of Experience.
Good communication, flexibility, reliability
Knowledge in Microsoft outlook/excel/word/PPT.
Strong Analytical skills with the ability to investigate and resolve issues
Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.

Responsibilities:

Complete the necessary training and meet the expectations outlined for the position.

Follow all standard operating procedures (SOP) diligently.
Complete audits promptly and ensure high quality.
Strive to meet both quality and production targets.
Adhere to project protocols and instructions.
Report any issues or trends promptly.
Maintain the logs (such as productivity, clarification, and others as applicable) updated.
Seek clarification from the manager or team leader when needed.
Promptly respond to all emails from the manager.
Ensure compliance with all relevant regulations and policies.

About the Company

EXL

Analyzes business data and runs outsourced operations

EXL analyzes business data and runs outsourced operations for insurers, healthcare payers, banks, retailers, and other large organizations. Its teams combine industry expertise with data engineering and AI to handle tasks such as claims processing, payment reviews, customer service, and finance within existing technology environments. The company also builds software, including LifePRO, which manages insurance policies, and EXLdata.ai, which connects fragmented data for use in AI systems. Clients pay for consulting projects, ongoing managed services, and software delivered through the cloud. EXL was founded in 1999 and is headquartered in New York City.

Company size: 10,001+
Company stage: IPO
Headquarters: New York City, New York
Founded: 1999

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