What are the responsibilities and job description for the Auditor III - Data Mining position at EXL Services?
Company Overview and Culture
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 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
EXL Health is looking for a Data Mining Auditor lll. This is 100% remote work from home opportunity!
In this role you will collaborate with Payment Integrity Audit program leaders to assist clients in controlling healthcare costs by performing Data Mining Audit reviews.
The successful candidate will be passionate, quality focused and have a background in Payment Integrity Audits and Medical Claims Processing/Pricing. The Data Mining Auditor is responsible for performing audit reviews to determine if correct payments were made to providers.
Responsibilities:
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
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 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
EXL Health is looking for a Data Mining Auditor lll. This is 100% remote work from home opportunity!
In this role you will collaborate with Payment Integrity Audit program leaders to assist clients in controlling healthcare costs by performing Data Mining Audit reviews.
The successful candidate will be passionate, quality focused and have a background in Payment Integrity Audits and Medical Claims Processing/Pricing. The Data Mining Auditor is responsible for performing audit reviews to determine if correct payments were made to providers.
Responsibilities:
- Perform an extensive review of client accounts to determine if correct payment were made to providers.
- Accurately reprice complex claims utilizing client claim systems.
- Identify work file to be audited through a query process.
- Review provider contracts/fee schedules to determine payment methodology.
- Documentation of audit findings to be shared with client.
- Evaluate current procedures for efficiency and accuracy.
- Recommend solutions for process improvements.
- Performed other duties as assigned.
- Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.
- 5-7 years of Medical Claims Processing/Pricing Experience with a background in Payment Integrity Audits a plus.
- Knowledge of CMS Pricing Guidelines and Coding Methodologies
- Strong analytical skills, with attention to details
- Excellent oral and written communication skills
- Strong skillset in Excel, Database Knowledge, and Word
- High School Diploma
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
