Specialist - Payment Accuracy I

Cotiviti; Pune District; On-site; INR 400,000 - 600,000; Full time

Job summary

Cotiviti is seeking a Specialist Payment Accuracy I in Pune to independently conduct complex audits on client systems, validate claim adjudications, and improve accuracy and compliance practices. The role involves leading audit projects, calling payers, and delivering actionable insights to management.

The candidate should have 1–3 years of relevant experience, a Bachelor's degree, proficiency in Microsoft Office and data analysis, and willingness to work night shifts while handling multiple

Qualifications

• Bachelor's degree required.
• 1–3 years of relevant experience (auditing, claims, billing, reimbursement, data analysis).
• Proficient in Microsoft Office; Access preferred.
• Excellent verbal and written communication; healthcare industry experience desired.
• Willingness to work night shifts and manage multiple projects.

Responsibilities

• Calling multiple payers to capture information.
• Perform audits based on client policies and procedures.
• Ensure compliance with established internal control procedures.
• Collect accurate information and documents to proceed with a claim.
• Make sure the overpayments for claims are accurate and correct by analyzing claims.
• Address inventory to be compliant based on client requirements.
• Meet the established SLAs for production and quality.
• Update the outcome of the work or analysis in clear documentation.
• Utilize SOPs and stay updated with changes.
• Improve performance based on feedback from the manager/quality audit team.
• Exhibit behavior consistent with Cotiviti values.

Skills

Auditing

Data analysis

Communication skills

Night shifts

Education

Bachelor's degree

Tools

MS Office

Access

Job description

Title: Specialist Payment Accuracy I

Job Summary: The Specialist Payment Accuracy I is responsible for independently conducting complex audits on client systems, validating claim adjudications, and ensuring the accuracy and compliance practices. This role involves leading audit projects, calling multiple payers, providing actionable insights, and collaborating with management to enhance audit effectiveness and operational risk controls. The Specialist Payment Accuracy I documents detailed findings and develops recommendations to improve claim accuracy and determine primacy audit outcomes and ensure quality and consistency.

Principal Responsibilities and Essential Duties:

• Calling Multiple payers to capture the required information.
• Perform audits based on clients policies and procedures and identify over payments
• Ensures compliance with established internal control procedures by examining operating procedures and related documentations
• Collect accurate information and documents to proceed with a claim
• Make sure the overpayments for claims are accurate and correct by analyzing claims and supporting documentation
• Address assigned inventory to be compliant based on the client requirements.
• Utilization of all possible tools and applications available to take account to the next level of resolution.
• Meet the established SLAs (service level agreements) for production and quality
• Update the outcome of the work or analysis in a clear documentation.
• Utilize the process SOP and stay updated with changes done with the SOPs
• Improve the performance based on the feedback provided by the reporting manager / quality audit team
• Exhibit behavior consistent with Cotiviti Values

Customer Driven

• Collaborative
• Accountable
• Open

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Required

Requirements:

• At least 1-3 years of relevant experience (auditing, claims, billing, reimbursement, data analysis)
• Freshers with excellent communication.
• Bachelors degree required.
• Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred
• Strong interest in working with large data sets and various databases
• Healthcare industry experience desired
• Excellent verbal and written communication skills
• Self-motivated and driven to succeed
• Good Communication skills
• Must be ready to work night shifts
• Should be ready to work on multiple projects simultaneously