6 Claims Auditing Jobs

Claims Auditor India Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviewsencompassing both outpatient/professional and inpatient claimsto ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated ...

As a Strategic Consultant at EXL Health, your role will involve driving healthcare-focused growth, transformation, and account strategy initiatives. You will be responsible for executing complex business transformations, identifying growth opportunities, and supporting strategic M&A decisions within the healthcare sector. The ideal candidate for this role possesses strong analytical abilities, a growth-oriented mindset, and a passion for making impactful changes in healthcare. Key Responsibilities: - Conduct in-depth analysis of clients" existing processes and market positioning to identify growth and transformation opportunities - Develop data-driven insights to form effective business stra...

As a detail-oriented and experienced Claim & Quality Auditor, your role will involve ensuring accuracy, compliance, and efficiency across the claims process. You will be responsible for the following key responsibilities: - Conduct regular audits of insurance claims (health, life, motor, or general) to ensure compliance with internal policies and regulatory guidelines. - Review claim documentation, approvals, and settlements for accuracy, completeness, and consistency. - Identify discrepancies, errors, or potential fraud and provide detailed audit findings to relevant stakeholders. - Develop and implement quality assurance metrics and audit checklists. - Collaborate with claims, underwriting...

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....

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 cru...

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 workin...