Senior Executive-Auditors-Datamining chez exl Service.com (India) Private Limited
exl Service.com (India) Private Limited · Chennai, Inde · Hybrid
- Senior
- Bureau à 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.
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:
- Graduation is Mandatory
- Claims adjudication experience is Mandatory
- Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory)
Experience:
- Claims Adjudication experience: Minimum 3 years
- Overpayment experience (Optional)
Communication:
- Strong written (documentation) and oral communication skills
Working Hours:
- 40 hours per week as Full time employee
- Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
- Weekends : Off
Telecommuter/Internet requirements, if applicable:
- High Speed internet connection at home, must be broadband
- Must understand and adhere with telecommuter policy
