The Auditor II – DM (Data Mining) reviews the output of queries to identify potential overpayments and performs the audit following set internal policies and procedures in accordance with the regulations and set contractual agreements between insurers and providers. Exercises independent decision making and professional judgment, using medical claims knowledge on a regular basis. The Auditor I determines if a discrepancy exists and documents the findings using standard documentation guidelines as applicable. *Base Pay Range: $18.50 - $30.00/hr For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Reviews output of queries for overpayments. Follow Query Step-by-Step Documentation to validate overpayments. If available, utilize claims system(s) to verify overpayments. Document overpayments/non overpayments in production systems. Claims not overpaid should have clear reasons articulated for research purposes and quality assurance. Meet quality and production standards. Record production tasks and time into format outlined by Management. Communicate to Management any issue(s) that would impede completion of assigned work. Work with Management to ensure these issues are resolved. Provide feedback to Management on areas of improvement.
Attention to Detail Excellent written and oral communication skills Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities Must be able to learn, understand, and apply new technologies Knowledge CMS guidelines Strong knowledge of HCPC, CPT and other coding methodologies Spreadsheet, word processing, and database knowledge
Educational Qualifications:
High School Diploma or Equivalent Required College Degree or Equivalent Work Experience Maintain OIG/GSA clearances
Preferred Experience:
1-2 Years’ Experience Auditor 1-2 Years’ Experience with Medical Claims Processing *The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
EXL 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 (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.