Senior Executive - Claims Audit
- LocationChennai, Tamil Nadu, India
- Work typeHybrid
- Posted26 October 2026
- SourceEXL's careers page (Oracle Recruiting)
Live checkFirst seen 7 days ago; still listed on EXL's careers page 1 h ago.
Moves fastWhen EXL takes a role down early, it is usually about 6 days after posting. Apply soon.
At a glance
- Experience3 to 5 years
Read from the ad by RoleFinder, with rules and an AI reading; the description is the source.
About the role
Job description:
- 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.
Responsibilities
Responsibilities:
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.
Qualifications
Qualifications: Any Graduate/ Postgraduate
Working Hours: 40 hours /week, Full Time Employee
Work Model: Training from office for 2 - months and hybrid there after
Telecommuter/Internet requirements, if applicable: High Speed internet connection and Power back up
Skills and abilities:
3-5 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.
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