EXL
EXL
EXL is a business consulting and services company that helps organizations use data, analytics, and technology to improve operations and make better decisions. Its work includes operations management, decision analytics, and digital transformation, with experience supporting clients in healthcare, insurance, finance, and logistics. EXL combines data science with practical business expertise to develop solutions tailored to each organization’s goals, operating model, and industry context.

Senior Executive, Claims Audit

Review healthcare records and claims at EXL for accuracy, documentation, and regulatory compliance. Support timely audits and quality assurance.

Description

  • Review medical records and claims data for accuracy, completeness, and regulatory compliance.
  • Verify clinical documentation supporting claim submissions and medical necessity.
  • Investigate and address inconsistencies, errors, and missing documentation.
  • Manage workloads to meet deadlines for expedited and high-priority cases.
  • Work with healthcare providers, coders, and billing staff.
  • Apply HIPAA, CMS, and other medical-record and claims-processing regulations.
  • Prepare reports summarizing claim findings, trends, and process improvements.
  • Contribute to internal audits and quality assurance work.
  • Complete audits on schedule while meeting quality and production targets.
  • Follow standard operating procedures, project protocols, and applicable regulations.
  • Report issues and trends, maintain productivity and clarification logs, and respond to manager emails.
  • Request guidance from managers or team leaders when needed.

Requirements

  • Graduate or postgraduate degree.
  • 3–5 years of experience.
  • Good communication, flexibility, and reliability.
  • Knowledge of Microsoft Outlook, Excel, Word, and PowerPoint.
  • Strong analytical skills, including the ability to investigate and resolve issues.
  • Familiarity with HIPAA, Medicare, Medicaid, and other payer-specific regulations.
  • 40-hour workweek.
  • Full-time employment.

Benefits

  • A high-speed internet connection and power backup are required for telecommuting.
  • Hybrid work model after two months of office training.

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