Executive - Claims Audit

EXL · Chennai

Job description:

Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.

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.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.

Executive- Claims Analyst is responsible for reviewing and analyzing medical records and claims to ensure accuracy, completeness, and compliance with regulatory standards. This role involves summarizing medical documentation, identifying missing information, and prioritizing workloads to ensure timely and accurate claim processing.

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