Assistant Manager

EXL; Hyderabad; On-site; INR 1,500,000 - 2,200,000; Full time

Job summary

EXL is seeking a Lead Assistant Manager with 9+ years of hands-on experience in claims adjudication, processing methods, and data mining capabilities. The ideal candidate understands the US healthcare system, payer analytics, and Medicare/Commercial data mining.

The role focuses on auditing claims to identify overpayments, refining concepts to reduce false positives, and driving revenue through data-driven insights. Strong interpersonal skills and the ability to work independently are essential.

Qualifications

• Minimum 9 years of claims adjudication experience.
• Experience with Medicare or Commercial line of business data mining preferred.
• Strong ability to audit claims and identify overpayments.
• Metrics and target-driven role with accuracy in audits.
• Strong interpersonal and independent working abilities.

Responsibilities

• Audit Medicare or Commercial claims for overpayments using data mining concepts.
• Identify true overpayments and refine concepts to reduce false positives.
• Develop new ideas to refine data mining concepts for higher revenue.
• Operate in a metrics-driven, target-driven environment.
• Collaborate with other teams and work independently with minimal guidance.
• Regularly discuss program progress with the manager.

Skills

Claims adjudication

Data mining

Healthcare payer analytics

US healthcare system knowledge

Interpersonal skills

Independent worker

Job description

EXL Looking for a Lead Assistant manager with a minimum of 9+ years of experience and must have in-depth knowledge of claims adjudication process and its processing methods. Data mining experience will be an added advantage.

Skills and abilities:

• Should have a good understanding of the US healthcare system and management.
• Should have thorough understanding of healthcare payer analytics specifically the business model for datamining operations.
• Preferably candidates should have work experience in the data mining Medicare or Commercial line of business.
• Should have thorough understanding of the payer system loopholes in the claims cost management.
• Should be able to think beyond horizon as ways to clog in those gaps for realizing higher revenue for datamining program.
• Will be responsible for auditing claims on Medicare or Commercial business based various data mining concepts to find overpayments.
• Will be responsible for bringing in new idea to refine concept to remove false positive
• The position is purely metrics and target driven in the perspective of claim audits to initiate overpayment that exist in deployed data mining concepts.
• The position will be strictly evaluated based on the accuracy over claim audits and overpayments identification
• Should possess a strong interpersonal skill set to be able to work well with other people/teams, including in teams or groups, formally and informally.
• Should be able to work independently with minimal guidance.
• Should be purely data and metrics driven person and discuss with Manager on a regular basis on the program/individual.

Must have:

• Claims Adjudication experience: Minimum 9 years
• Prefer candidates with experience in Post adjudication/overpayment projects.