Claims Auditor

3 weeks ago

Chennai, India EXL Full time

About the Role - Looking for Claims Auditor in Healthcare - Min 3 Years of experience.


Responsibilities -

  • Specifically in Claims adjudication, claims processing, pricing, administrative records review experience pertinent to US Healthcare PAYOR domain
  • Medical Records Management, Clinical Audit based on Medical Records Review, Seasoned experience in US Healthcare (Payer/Provider LOB)
  • Preferred to have worked over a period of time in US Healthcare payer/provider domain
  • Understand the business model for our delivery center and then implement the same in the training vertical
  • Should have effective communication skills to coordinate with program SMEs and candidates
  • Should be well accustomed with reporting, presentations, creating training materials (videos/document) in granular level
  • Should possess understanding of High Cost Drug and Durable Medical equipment auditing through Medical records review
  • Previously working for US Healthcare Payer vertical/LOB will be an added advantage
  • Follow every aspect of SOP without fail
  • Complete received Audits with Quality
  • To meet the team/Client Quality and 100% of production target on a daily basis
  • Follow project related protocols and instructions
  • Escalate issues, identify trends...
  • Update all the logs like productivity, Clarification log, and any other logs applicable on a daily basis
  • Should be read to extend support working on weekends a and when applicable
  • Should be a good team member to ensure the smooth service delivery
  • Should be a good and fast learner
  • All emails from Leads, Team members, Manager and higher hierarchy should be answered promptly without fail
  • Ensure Healthcare compliance of entire team for HIPAA, OIG, PHI etc.


Qualifications - Graduation is mandatory (bachelor's degree)

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