3 Claims Auditing Jobs

About the Role: We are looking for an experienced and forward-thinking Strategic Consultant to lead healthcare-focused growth, transformation, and account strategy initiatives. Your responsibilities will include executing complex business transformations, identifying growth opportunities, and supporting strategic M&A decisions within the healthcare sector. The ideal candidate will have strong analytical abilities, a growth-oriented mindset, and a passion for driving impactful changes in healthcare. Key Responsibilities: Strategic Analysis & Insights Development: Conduct in-depth analysis of clients" existing processes and market positioning to uncover growth and transformation opportunities. Develop data-driven insights to form effective business strategies, especially within the healthcare sector. Business Transformation Leadership: Lead business transformation projects by evaluating current workflows, identifying inefficiencies, and designing optimized solutions to enhance overall performance. Collaborate with stakeholders for seamless integration of transformative initiatives. Growth-Oriented Planning: Create and implement growth-focused strategies based on market insights and industry trends to support clients" expansion and operational goals in healthcare. Drive initiatives that promote revenue growth, market expansion, and service innovation. Account Strategy Development: Develop and refine account strategies aligned with clients" goals, focusing on strengthening relationships, improving service delivery, and enhancing customer satisfaction. Create targeted plans for account growth and long-term client success. M&A Research and Analysis: Conduct thorough research and due diligence for mergers and acquisitions, assessing potential opportunities and risks to guide strategic decisions. Provide actionable recommendations aligned with clients" growth and transformation objectives. Continuous Market & Industry Research: Stay updated on industry trends, healthcare regulations, and emerging market opportunities to offer forward-looking strategies that maintain a competitive edge for clients. Cross-Functional Collaboration: Collaborate closely with internal teams and client stakeholders to implement strategic initiatives. Offer guidance and support throughout project phases and facilitate alignment with growth objectives. Effective Communication of Insights: Present complex analyses and strategic recommendations to client stakeholders and senior leadership in a clear and compelling manner. Build strong client relationships by articulating the value of proposed strategies and transformation initiatives effectively. Qualifications: - Education: Bachelors or MBA degree. - Adaptability and Flexibility: Ability to work effectively across various time zones and diverse business environments. - Technical Skills: Knowledge of healthcare systems, clinical workflows, financial models, and data analytics tools. - Soft Skills: Strong leadership, project management, communication, and problem-solving skills with a passion for collaboration in a fast-paced setting. Preferred Skills: Background in claims auditing, healthcare technology, population health, or business development. Experience in strategy development for value-based care or healthcare coordination is a plus. Our Values: - Teamwork: Prioritizing collaboration with diverse teams to achieve shared goals. - Continuous Learning: Fostering an environment that encourages growth and development in alignment with the future of healthcare. - Customer-Centric Focus: Understanding and meeting customer needs to drive value in every interaction. - Adaptability: Leading through change and championing innovation for individual and organizational success. What We Offer: EXL Health provides an exciting and innovative environment where you can work with experienced Healthcare consultants from day one. You will gain insights into various business aspects, develop teamwork, and time-management skills. We offer guidance through mentoring programs and opportunities for personal and professional growth within the company. Why Join EXL Health : - Inclusive and Dynamic Culture: Embracing diverse perspectives and fostering continuous learning and growth. - Innovative Environment: Being part of a forward-thinking team that values and promotes innovation and creativity. Apply today to redefine healthcare solutions and drive better outcomes. Your expertise and leadership can create a significant impact!,

As a Medical Claims Auditor at ABC Hospital in Palasi, you will play a crucial role in auditing medical claims to ensure accuracy and compliance with insurance policies and regulations. Your responsibilities will include reviewing and verifying claim information, analyzing claims for discrepancies, and making necessary corrections. Your strong analytical skills will be essential in handling claims effectively and ensuring proper documentation. To excel in this role, you should possess Claims Auditing and Claims Handling skills, along with experience in Insurance and Auditing practices. Attention to detail is key in this position, and your organizational and time-management skills will be crucial in meeting deadlines and maintaining accuracy. Effective communication and interpersonal abilities are also important as you will be liaising with various stakeholders to resolve claim issues. While previous experience in a medical setting is a plus, a Bachelor's degree in Healthcare Administration, Accounting, or a related field is required for this position. Join our team at ABC Hospital and become part of a dynamic environment dedicated to providing quality healthcare services in the region.,

Roles and Responsibilities Conduct medical audits for high-value claims, including inpatient and outpatient services. Review NCCI guidelines to ensure accurate coding and compliance with US healthcare regulations. Analyze CPT codes to identify discrepancies and optimize claim processing. Collaborate with internal stakeholders to resolve issues related to claims adjudication. Develop expertise in dollar value claims handling, focusing on accuracy and efficiency. Desired Candidate Profile 6-11 years of experience in Medical Audit or Claims Auditing/Audition role. Strong understanding of CPT, ICD-10-CM/PCS, HCPCS Level II codes; knowledge of anesthesia codes (G0152) preferred. Experience working with High Value Claims (HVC) is essential; familiarity with NCCI guidelines a plus.