Hybrid Executive - Claims Analyst - Repricing and Extended Functions

at EXL

• Job title: Executive - Claims Analyst - Repricing and Extended Functions
• Job type: Full Time
• Experience level: Junior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Chennai, India

About the role

• Claims Analyst reviewing and analyzing medical records and claims for accuracy and compliance with regulations. Collaborating with healthcare providers and supporting audits within defined timelines.

Responsibilities

• 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.

Requirements

• Any Graduate/Postgraduate
• 1-3 years of Experience
• Good communication, flexibility, reliability
• Knowledge in Microsoft Outlook/Excel/Word/PPT
• Strong Analytical skills with the ability to investigate and resolve issues
• Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.

Benefits

• Complete the necessary training and meet the expectations outlined for the position.
• Follow all standard operating procedures (SOP) diligently.
• Complete audits promptly and ensure high quality.
• Strive to meet both quality and production targets.
• Adhere to project protocols and instructions.
• Report any issues or trends promptly.
• Maintain the logs (such as productivity, clarification, and others as applicable) updated.
• Seek clarification from the manager or team leader when needed.
• Promptly respond to all emails from the manager.
• Ensure compliance with all relevant regulations and policies.