Hybrid Senior Executive – Auditors, Datamining

Posted 2 days ago

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About the role

  • 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.
  • 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
  • High Speed internet connection at home, must be broadband
  • Must understand and adhere with telecommuter policy

Benefits

  • Health insurance
  • Professional development opportunities

Job title

Senior Executive – Auditors, Datamining

Job type

Experience level

Senior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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