Hybrid Senior Auditor – Data Mining

at EXL

• Job title: Senior Auditor – Data Mining
• Job type: Full Time
• Experience level: Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Chennai, India

About the role

• Senior Executive at EXL handling healthcare claims processing and data mining initiatives. Ensuring compliance and quality while optimizing revenue through data analysis.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• Follow all compliance protocols, company policies, and HIPAA guidelines without fail.
• Ensure data confidentiality and integrity are maintained at all times.
• Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.
• Contribute proactively to process improvement and efficiency initiatives.

Requirements

• Graduation is Mandatory
• Claims adjudication experience is Mandatory
• Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory)
• Claims Adjudication experience: Minimum 3 years
• Overpayment experience (Optional)
• Strong written (documentation) and oral communication skills
• 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)
• High Speed internet connection at home, must be broadband
• Must understand and adhere with telecommuter policy

Benefits

• 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.