ID
Auditor for ISO management standards at Intertek, ensuring compliance in quality and environmental management. Working in Germany with flexible working hours and health promotion benefits.
About the role
- Senior Executive in healthcare claims processing and data mining at EXL, ensuring compliance and quality standards while optimizing revenue opportunities.
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.
- 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
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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