Perform claims adjudication and data mining for healthcare payer accounts. Calculate payment determinations without system support, meet quality and TAT targets, produce reports, ensure compliance, communicate with stakeholders, and work independently on assigned inventory.
Job Description_ Contingency _Data Mining Job Name: Senior Executive - Datamining Position Title: Senior Executive Band: A2 ERP Full Position ID: Reporting to: Assistant Manager Location/Site: EXL India Overview Candidates should have minimum 3+ years of experience and must have knowledge in claims adjudication process and its processing methods. Qualifications: Graduation is Mandatory Claims adjudication experience is Mandatory Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory) Experience: Claims Adjudication experience: Minimum 3 years Overpayment experience (Optional) Communication: Strong written (documentation) and oral communication skills Working Hours: 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) Weekends : Off Telecommuter/Internet requirements, if applicable: High Speed internet connection at home, must be broadband Must understand and adhere with telecommuter policy Skills and abilities: 3+ years of experience in claims processing or claims adjudication. Should have a strong US healthcare knowledge. Should know the payment determination. Which means candidates should calculate the allowable without system support. Should identify the gaps for realizing higher revenue for data mining program. Should have a good communication with neutral accent preferred. Ensure assigned inventory should be completed with quality within TAT. Production, quality and other reports should update on timely manner as required. Must ensure availability for meeting/calls as required. Should be able to work independently with minimal guidance. Ensure candidates should follow compliance protocols without fail.
About the TeamEXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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