Senior Manager - Diagnosis-Related Group (DRG) Data Analyst

ExlService Holdings, Inc.; Northern (KY); Hybrid; USD 120,000 - 125,000; Full time

Job summary

ExlService Holdings, Inc. is seeking a Senior Manager DRG Data Analyst to evaluate utilization trends and analyze medical health claim data. You will identify root causes and develop cost-effective quality products and services, working independently in a fast-paced environment.

The role emphasizes experience with health care claims and MS-DRG/APR-DRG payments, with additional exposure to Outpatient, ASC, SNF, Rehab, Professional, DME, and related claims as a plus.

Qualifications

• Experience analyzing healthcare claims data.
• Understanding of inpatient MS-DRG/APR-DRG payments.
• Strong root-cause analysis capabilities.
• Ability to organize and analyze large datasets.

Responsibilities

• Evaluate trends in utilization of products/services using historical data.
• Retrieve, organize and analyze medical health claim data.
• Identify root causes and provide data-driven insights.
• Support rapid, independent work in a fast-paced environment.

Skills

Healthcare claims analysis

MS-DRG/APR-DRG payments

Root cause analysis

Data analysis

Job description

The Senior Manager Diagnosis Related Groug (DRG) Data Analyst will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently. Candidate should have experience and knowledge in health care claims and a strong understanding of inpatient MS-DRG/APR-DRG payments. Additional experience with Outpatient, ASC, SNF, Rehab, Professional, DME, HCD/HIT claims is a plus. Previous claim payment experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with provider billing practices, claim system limitations, provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.

Salary Range for this role is: $120k - $125k

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

The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.