Senior Executive-Auditors-Datamining

EXL; Chennai District; On-site; INR 550,000 - 900,000; Full time

Job summary

EXL in Chennai is seeking professionals for Claims Processing & Adjudication to review and process healthcare claims in line with payer rules, guidelines, and contractual terms. The role includes data-driven revenue opportunities, ensuring HIPAA compliance, and independent initiative to drive process improvements.

You will collaborate with internal teams, maintain accuracy and timely completion of claims, and contribute to production and quality reporting while upholding confidentiality and data

Responsibilities

• Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.
• Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.
• Perform manual payment determination and allowable calculations without relying on system tools.
• Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.
• Support data mining programs by providing insights for revenue realization and process improvement.
• Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards.
• Prepare and update production, quality, and status reports regularly as per business requirements.
• Maintain clear and professional communication with internal teams and stakeholders.
• Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues.
• Follow all compliance protocols, company policies, and HIPAA guidelines without fail.
• Ensure data confidentiality and integrity are maintained at all times.
• Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.
• Contribute proactively to process improvement and efficiency initiatives.

Job description

Claims Processing & Adjudication

• Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.

Claims Processing & Adjudication

• Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.
• Perform manual payment determination and allowable calculations without relying on system tools.

Revenue Optimization & Data Mining

• Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.
• Support data mining programs by providing insights for revenue realization and process improvement.

Quality & Productivity Management

• Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards.
• Prepare and update production, quality, and status reports regularly as per business requirements.

Communication & Coordination

• Maintain clear and professional communication with internal teams and stakeholders.
• Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues.

Compliance & Process Adherence

• Follow all compliance protocols, company policies, and HIPAA guidelines without fail.
• Ensure data confidentiality and integrity are maintained at all times.

Independence & Initiative

• Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.
• Contribute proactively to process improvement and efficiency initiatives.