Senior Executive - Claims Audit

EXL Talent Acquisition Team; Chennai; On-site; INR 350,000 - 550,000; Full time

Job summary

EXL Talent Acquisition Team in Chennai, India is seeking candidates for a claims processing and revenue optimization role. You will review, analyze, and process healthcare claims according to payer rules and contractual terms, and perform manual payment determinations without relying on system tools.

You will contribute to data mining efforts to uncover revenue opportunities, ensure quality and timely completion of claims, maintain HIPAA compliance and participate in meetings to resolve process

Qualifications

• Experience in healthcare claims processing or adjudication.
• Ability to analyze payer rules, guidelines and contractual terms.
• Proficiency in data mining for revenue opportunities.
• Strong communication with internal teams and stakeholders.

Responsibilities

• Review, analyze and process healthcare claims according to payer rules.
• Perform manual payment determinations and calculations.
• Identify gaps and underpayments through data analysis and reviews.
• Prepare production and quality reports on request.
• Participate in meetings and discussions to resolve issues.

Skills

Attention to detail

Data analysis

Communication

Independence

Job description

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.