Senior Executive – Claims Audit

EXL

Senior Executive - Claims Audit reviewing medical records and claims for compliance at EXL. Collaborating with providers to resolve discrepancies and improve processes while maintaining healthcare regulations.

Posted 6/30/2026full-timeChennai • 🇮🇳 IndiaSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reviewing and analyzing medical records and claims data for accuracy and compliance with healthcare regulations. Proficient in collaborating with healthcare providers and utilizing coding standards to support claim submissions and process improvements.

Highest-signal resume keywords

Medical Record AnalysisClaims ProcessingHIPAA ComplianceStrong Analytical SkillsHealthcare Terminology

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Data ReviewClinical Documentation VerificationCoding Standards (ICD, CPT, HCPCS)Regulatory ComplianceProcess Improvement

Soft Skills

Good CommunicationFlexibilityReliability

Tools & Technologies

Microsoft OutlookMicrosoft ExcelMicrosoft WordMicrosoft PowerPoint

Industry Keywords

HIPAAMedicareMedicaidPayer RegulationsQuality Assurance

About the role

Key responsibilities & impact

Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.

Requirements

What you’ll need

Any Graduate/ Postgraduate
3-5 years of Experience
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.

Benefits

Comp & perks

Working Hours: 40 hours /week, Full Time Employee
Work Model: Training from office for 2 - months and hybrid thereafter
Telecommuter/Internet requirements: High Speed internet connection and Power back up