EXL

Executive

EXL  •  Noida, IN (Onsite)  •  2 days ago
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Job Description

Basic Function

This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims.

Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.

Essential Functions

  • Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
  • Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
  • Deep understanding of medical coding, billing, and medical terminologies
  • Attention for detail, and Strong analytical skills for processing medical documentation
  • Critical thinking and high independent decision making capability
  • Proficiency in healthcare information systems
  • Ability to navigate through multiple applications
  • Operates with urgency in a real time service environment
  • Meets individual goals while assisting team to meet team goals
  • Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
  • May perform other duties as assigned
  • Making outbound calls to agent, hospitals, pharmacy and doctors office to capture missing or required information

Performance parameters

  • Productivity
  • Quality
  • Turn Around Time of work assigned

  • Attendance & Schedule Adherence


Primary Internal Interactions:

  • SME/AM/LAM/Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking support
  • AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
  • SME for the purpose of handling process related issues; queries and escalated transactions
  • QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
  • Mentors for the purpose of seeking clarifications and answering queries real time

Basic Function

This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims.

Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.

Essential Functions

  • Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
  • Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
  • Deep understanding of medical coding, billing, and medical terminologies
  • Attention for detail, and Strong analytical skills for processing medical documentation
  • Critical thinking and high independent decision making capability
  • Proficiency in healthcare information systems
  • Ability to navigate through multiple applications
  • Operates with urgency in a real time service environment
  • Meets individual goals while assisting team to meet team goals
  • Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
  • May perform other duties as assigned
  • Making outbound calls to agent, hospitals, pharmacy and doctors office to capture missing or required information

Performance parameters

  • Productivity
  • Quality
  • Turn Around Time of work assigned

  • Attendance & Schedule Adherence


Primary Internal Interactions:

  • SME/AM/LAM/Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking support
  • AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
  • SME for the purpose of handling process related issues; queries and escalated transactions
  • QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
  • Mentors for the purpose of seeking clarifications and answering queries real time


Organizational Relationships Reports To: Assistant Manager/Lead Assistant Manager
Skills
Desirable Skills

  • Critical thinking and high independent decision making
  • Strong analytical, Reasoning, and problem solving skills
  • Medium competency in excel skills
  • Ability to comprehend in English (written and verbal) for structured communication, including drafting effective emails and instant messages (IMs) for internal and external teams, as well as making professional calls to agent, hospitals, pharmacy and doctors office
  • Ability to respond to all inquiries within a timely manner
  • Strong interpersonal and communication skills – both verbal and written
  • Adaptability/Ability to interpret variable input details


Technical Skills

  • Good computer navigation skills
  • Typing speed of 25 Words per Minute with 90% Accuracy
  • Proficiency in healthcare information systems
  • Ability to navigate through multiple applications

Process Specific Skills

  • Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
  • Deep understanding of medical coding, billing, and medical terminologies
  • Ability to produce high quality in production in environment.
  • Ability to troubleshoot, identify user errors vs. system mapping errors (enrollment dates, method, system logic)

Soft skills

  • Ability to work independently
  • Ability to understand and question established process guidelines for possible process improvements
  • Attention for detail, and Strong analytical skills for processing medical documentation
  • Possess keen sense of acquiring knowledge

  • Adaptable and flexible to work in night shifts

Education Requirements and Work Experience:

  • Bachelor’s degree in relevant field such as Biology, Biochemistry, Biotechnology, BPT, MPT, BDS etc
  • Computer literacy
  • Candidates with relevant business experience more than 1 year will be preferred
EXL

About EXL

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.

Industry
Consulting & Advisory
Company Size
10,000+ employees
Headquarters
New York, NY
Year Founded
Unknown
Website
exlservice.com
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