Manager - Claims & Payment Integrity- US Healthcare- 9+ Yrs- Hyderabad

Manager / Senior Manager - Claims Domain SME - Claims Adjudication & Payment Integrity - Data Mining - US Healthcare - 9+ Years - Hyderabad

Claims Domain SME

Location: Hyderabad

Your Future Employer:

Responsibilities:

1. Analyze claims data to identify utilization patterns, anomalies and potential overpayments.
2. Leverage knowledge of CMS rules, reimbursement and claims workflows to support investigations.
3. Perform root-cause analysis of claims outcomes and payment issues.
4. Translate claims insights into analytics, data-mining use cases and solution concepts.
5. Collaborate with analytics, product and strategy teams to validate and scale payment integrity solutions.

Requirements:

1. 7+ years of experience in

   US Healthcare Claims

   with strong claims adjudication expertise.
2. Strong experience in

   Claims Review, Claims Audit and Payment Integrity

   .
3. Expertise in

   Overpayment Identification, Payment Accuracy or Recovery

   .
4. Exposure to

   Claims Data Mining / Claims Analytics

   and identification of anomalies and patterns.
5. Experience across

   Medicare, Medicaid or Commercial Healthcare

   , with knowledge of CMS rules and reimbursement.

Whats in it for you?

Lead innovative initiatives in US Healthcare Payment Integrity
Work closely with Analytics, Product and Strategy teamsLeverage claims expertise to shape data-driven solutionsOpportunity to drive large-scale claims monitoring and overpayment detection

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