Claims Review and Verification
Conduct post-audit reviews of healthcare claims to ensure accuracy and compliance with payer policies, regulations, and billing guidelines.
Verify that claims are billed correctly, including checking codes, modifiers, and the application of benefits.
Error Identification and Resolution:
Identify and analyze discrepancies or errors in claims processing.
Work with claims processors and providers to resolve issues or discrepancies.
Prepare and document findings and recommendations for corrections.
Ensure that claims processing adheres to federal, state, and payer-specific regulations.
Stay updated on changes in healthcare regulations and payer policies to ensure compliance.
Reporting and Documentation
Generate detailed reports on audit findings, including error trends, compliance issues, and recommendations for process improvements.
Maintain accurate records of audits, findings, and resolutions.
Process Improvement:
Analyze audit results to identify areas for process improvement within the claims processing system.
Collaborate with internal teams to implement changes and improve claim accuracy and efficiency.
Provider and Payer Communication:
Communicate with healthcare providers and payers regarding audit findings, discrepancies, and required corrections.
Provide guidance and support to resolve issues related to claim processing.
Bachelor Degree in relevant field with 2 - 4 years of relevant experience
Choosing a digital partner is about more than capabilities — it’s about collaboration and character.
Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments.
At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations.
Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale.
Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact.
We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition.
At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward.
For more information, visit www.exlservice.com.
