Lead Payment Integrity Concept Architect

EXL Talent Acquisition Team; United States; On-site; USD 75,000 - 107,000; Full time

Job summary

EXL Talent Acquisition Team is seeking a Subject Matter Expert (SME) – Payment Integrity Concept Development to design, develop, and validate innovative payment integrity concepts that identify inaccurate healthcare claims. The role combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to drive high-value overpayment detection opportunities and measurable savings.

Base Pay Range listed: $75,100 - $107,300/yr.

Qualifications

• Proven ability to design payment integrity concepts.
• Experience validating healthcare claims with high clinical accuracy.
• Knowledge of reimbursement methodologies and regulatory guidance.
• Strong analytical skills and cross-functional collaboration.

Responsibilities

• Design, develop and validate innovative payment integrity concepts.
• Translate initial ideas into implementable solutions with measurable savings.
• Maintain high clinical accuracy and low provider abrasion while recovering overpayments.

Skills

Medical coding

Reimbursement methodologies

Claims analytics

Clinical documentation

Regulatory guidance

Job description

EXL Talent Acquisition Team is seeking a Subject Matter Expert (SME) – Payment Integrity Concept Development to design, develop, and validate innovative payment integrity concepts that identify inaccurate healthcare claims. The role combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to drive high-value overpayment detection opportunities and measurable savings.

Base Pay Range listed: $75,100 - $107,300/yr.