Senior Executive – Claims Audit

EXL

Senior Executive in Claims Audit processing and adjudicating healthcare claims accurately. Collaborating with internal teams and adhering to compliance protocols while improving processes.

Posted 7/8/2026full-timeChennai • 🇮🇳 IndiaSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare claims adjudication, ensuring compliance with payer rules and HIPAA guidelines while maintaining data confidentiality. Proficient in identifying revenue opportunities and contributing to process improvements through effective communication and data analysis.

Highest-signal resume keywords

Claims Adjudication ExperienceData AnalysisProcess ImprovementStrong Communication SkillsCompliance Adherence

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare Claims ProcessingPayment DeterminationAllowable CalculationsData MiningRevenue Realization

Soft Skills

Professional CommunicationAccountabilityProactive Contribution

Industry Keywords

Payer RulesPolicy GuidelinesContractual TermsTelecommuter PolicyHIPAA Guidelines

About the role

Key responsibilities & impact

Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.
Perform manual payment determination and allowable calculations without relying on system tools.
Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.
Support data mining programs by providing insights for revenue realization and process improvement.
Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards.
Prepare and update production, quality, and status reports regularly as per business requirements.
Maintain clear and professional communication with internal teams and stakeholders.
Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues.
Follow all compliance protocols, company policies, and HIPAA guidelines without fail.
Ensure data confidentiality and integrity are maintained at all times.
Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.
Contribute proactively to process improvement and efficiency initiatives.

Requirements

What you’ll need

Graduation is Mandatory
Claims adjudication experience is Mandatory
Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory)
Claims Adjudication experience: Minimum 4-5 years
Overpayment experience (Optional)
Strong written (documentation) and oral communication skills
High Speed internet connection at home, must be broadband
Must understand and adhere with telecommuter policy

Benefits

Comp & perks

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.