Senior Executive-Auditors-Datamining

1 week ago

Chennai, Tamil Nadu, India EXL Full time ₹ 6,00,000 - ₹ 12,10,000 per year
Description

Claims Processing & Adjudication:
Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.
Perform manual payment determination and allowable calculations without relying on system tools.

Revenue Optimization & Data Mining:
Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.
Support data mining programs by providing insights for revenue realization and process improvement.

Quality & Productivity Management:
Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards.
Prepare and update production, quality, and status reports regularly as per business requirements.

Communication & Coordination:
Maintain clear and professional communication with internal teams and stakeholders.
Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues.

Compliance & Process Adherence:
Follow all compliance protocols, company policies, and HIPAA guidelines without fail.
Ensure data confidentiality and integrity are maintained at all times.

Independence & Initiative:
Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.
Contribute proactively to process improvement and efficiency initiatives.

Responsibilities

Skills and abilities:

  • 3+ years of experience in claims processing or claims adjudication.
  • Should have a strong US healthcare knowledge.
  • Should know the payment determination. Which means candidates should calculate the allowable without system support.
  • Should identify the gaps for realizing higher revenue for data mining program.
  • Should have a good communication with neutral accent preferred.
  • Ensure assigned inventory should be completed with quality within TAT. 
  • Production, quality and other reports should update on timely manner as required.
  • Must ensure availability for meeting/calls as required.
  • Should be able to work independently with minimal guidance.
  • Ensure candidates should follow compliance protocols without fail.
Qualifications

Qualifications:

  1. Graduation is Mandatory 
  2. Claims adjudication experience is Mandatory
  3. Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory)  

Experience:

  1. Claims Adjudication experience: Minimum 3 years
  2. Overpayment experience (Optional)

Communication: 

  1. Strong written (documentation) and oral communication skills

Working Hours:

  1. 40 hours per week as Full time employee
  2. Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
  3. Weekends : Off

Telecommuter/Internet requirements, if applicable:

  1. High Speed internet connection at home, must be broadband
  2. Must understand and adhere with telecommuter policy

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