Senior Executive – Clinical Auditor

Getsetjobs; Chennai District; On-site; INR 400,000 - 700,000; Full time

Job summary

EXL is hiring a Senior Executive – Clinical Auditor in Chennai for experienced nursing professionals with strong clinical knowledge and an understanding of the US healthcare system. You’ll review medical claims against records to ensure documentation accuracy, identify discrepancies and provide recommendations to improve quality and reduce errors.

This role blends clinical expertise with healthcare auditing in a data-driven environment.

Qualifications

• Bachelor’s Degree in Nursing is required.
• Active State Nursing Certification mandatory.
• Minimum 3 years of clinical/hospital experience.
• Understanding of the US healthcare system.
• Strong clinical documentation and analytical skills.

Responsibilities

• Review medical claims against patient medical records.
• Identify documentation discrepancies and potential billing errors.
• Validate diagnoses, procedures and levels of care.
• Conduct clinical and best-practice audits.
• Identify documentation gaps, coding inaccuracies and revenue leakage opportunities.
• Prepare structured audit reports with corrective recommendations.
• Collaborate with coding, billing and provider teams.
• Monitor recurring audit trends and identify areas requiring intervention.
• Stay updated on CMS regulations, clinical guidelines and payer policies.
• Maintain audit accuracy and productivity targets.
• Review clinical information and make appropriate final determinations.

Skills

Clinical knowledge

Analytical skills

Attention to detail

Written communication

Team coordination

Problem solving

Education

Bachelor’s Degree in Nursing

Job description

Company: EXL Location: Chennai, Tamil Nadu, India Job Type: Full-Time Work Mode: On-site / Telecommuter option as applicable Experience: 3–6 years; minimum 3 years clinical/hospital experience Education: Bachelor’s Degree in Nursing; Active State Nursing Certification Mandatory Expected Salary: ₹4 – ₹7 Lakhs Per Year Job Category: Healthcare, Nursing, Clinical Auditing, Medical Coding, Clinical Operations Website: Website Contact: Contact us

Your clinical experience can take you beyond patient care.

A nursing career doesn’t always have to mean a hospital ward.

Sometimes, your next step is learning how to review the care, identify the gaps and improve the system behind it.

EXL is hiring a Senior Executive – Clinical Auditor in Chennai for experienced nursing professionals with strong clinical knowledge and an understanding of the US healthcare system.

This is where clinical expertise meets healthcare auditing, quality and data-driven decision-making.

About EXL:

EXL is a global analytics and digital transformation company serving businesses across industries, including healthcare. Its healthcare teams work across areas such as claims, clinical operations, analytics, quality and revenue-cycle management. This role gives clinical professionals an opportunity to apply their healthcare knowledge in a process-driven environment.

About the Role:

As a Clinical Auditor, you’ll review medical claims against patient medical records to determine whether documentation, diagnoses, procedures and billed services are accurate and complete. You’ll identify discrepancies, audit clinical documentation and provide recommendations that can improve quality and reduce errors. The role also involves working with coding, billing and provider teams while staying aligned with CMS guidelines, payer policies and regulatory requirements.

Key Responsibilities:

• Review and audit medical claims against patient medical records
• Identify documentation discrepancies and potential billing errors
• Validate diagnoses, procedures and levels of care
• Conduct clinical and best-practice audits
• Identify documentation gaps, coding inaccuracies and revenue leakage opportunities
• Prepare structured audit reports with corrective recommendations
• Collaborate with coding, billing and provider teams
• Monitor recurring audit trends and identify areas requiring intervention
• Support quality assurance initiatives
• Stay updated on CMS regulations, clinical guidelines and payer policies
• Maintain audit accuracy and productivity targets
• Review clinical information and make appropriate final determinations
• Maintain productivity, clarification and other required process logs
• Follow SOPs, project protocols and compliance requirements

Requirements:

• Bachelor’s Degree in Nursing
• Active State Nursing Certification is mandatory
• Minimum 3 years of clinical/hospital experience
• Strong understanding of medical terminology and clinical concepts
• Understanding of the US healthcare system
• Strong clinical documentation and analytical skills
• Good written and verbal communication
• Ability to work effectively with multidisciplinary teams
• Strong attention to detail
• Ability to analyse errors and identify corrective actions
• Auditing experience is an advantage but optional

Preferred Skills:

• Clinical Knowledge
• Medical Record Review
• Clinical Auditing
• Document Auditing
• US Healthcare
• CMS Guidelines
• Medical Claims
• Quality Assurance
• Healthcare Documentation
• Clinical Analysis
• Team Coordination
• Problem Solving

Why Consider This Opportunity:

• Move beyond traditional bedside nursing
• Apply your clinical knowledge to healthcare operations
• Gain experience in clinical auditing and quality assurance
• Work with US healthcare processes
• Develop skills in medical claims and documentation review
• Build expertise in compliance and healthcare quality
• Monday–Friday work schedule with weekends off
• 40 hours per week

Your nursing degree doesn’t define your career path. It gives you a foundation. From there, you can move into clinical auditing, quality assurance, utilization management, healthcare analytics, coding or clinical operations. The smartest career move isn’t always starting over. Sometimes, it’s taking what you already know — and applying it somewhere more valuable.