Senior Executive - Claims Audit
EXL · Chennai
- 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.
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.