Senior Executive

Job Name:

Repricing Analyst - Quality

Position Title:

Senior Executive - quality

Band:

A2

Domain :

Healthcare

Reporting to:

Assistant Manager

Location/Site:

EXL India, Chennai

Overview: The main objective of this position is to quality audit, validate, calculate, and accurately report any overpaid amounts in the system. As a quality auditor for Repricing Analyst, you will be auditing and analyzing claims to determine the precise overpaid amount and recording the outcomes in the client/internal system. Your contribution to these tasks will help us maintain the accuracy and integrity of our client's financial records.

Qualifications: Any Graduate/ Postgraduate

Working Hours: 40 hours /week, Full Time Employee

Telecommuter/Internet requirements, if applicable: High Speed internet connection and Power back up (preferred)

Skills and abilities:

• 3-6 years of Experience.
• Auditing experience is an advantage
• 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.

Job Description:

• Quality audit
• Verifying health insurance member information
• Analyzing paid claim details
• Identifying new paid amounts
• Calculating overpaid amounts accurately
• Maintaining comprehensive financial transaction records

Responsibilities:

• Understand Quality criteria
• 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.