Payment Integrity Concept Development SME

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

The Subject Matter Expert (SME) – Payment Integrity Concept Development is responsible for designing, developing, and validating innovative payment integrity concepts that identify inaccurate, inappropriate, or unsupported healthcare claims. This individual combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to develop high-value overpayment detection opportunities that generate measurable savings.

The ideal candidate has a proven history of successfully developing new payment integrity concepts from initial idea through implementation, resulting in significant financial recoveries while maintaining high clinical accuracy and low provider abrasion.

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

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits