Senior Executive - Claims Audit

Ex; Chennai District; On-site; INR 335,000 - 670,000; Full time

Job summary

Ex in Chennai seeks a detail‑oriented claims processor to review, analyze, and adjudicate healthcare claims, ensuring compliance with payer rules, policies, and contracts.

You will perform manual payment determinations, identify underpayments, and contribute to revenue optimization through data analysis while maintaining HIPAA-compliant practices.

This role emphasizes independent work, timely reporting, clear communication with stakeholders, and continuous process improvement.

Responsibilities

• 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, professional communication with internal teams and stakeholders; participate in meetings and calls to resolve issues.
• Follow all compliance protocols, company policies, and HIPAA guidelines while ensuring data confidentiality.
• Work independently with minimal supervision and proactively contribute to process improvement.

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.