Subject Matter Specialist

About EXL Health Payments Analytics:

At EXL Health Payments Analytics Center of Excellence, we would like to involve passionate individuals with growth/startup mindset to experiment, fail fast, learn and contribute to our 5 fold growth story of 100M to 500M Our Typical day : We are considered Special investigation Unit by 5 of top 10 US health insurance companies and others helping with their audit of fraud and overpaid claims. Our revenue is outcome driven which means health insurance companies provide data only and do not pay any consulting cost or resource-based billing upfront; unlike typical consulting and services companies. So, we make money by finding money for our clients in simple terms 'commission basis' We Productize algorithms and R&D accelerators that are intended to be used across multiple health insurance clients for the above business case.

About the Role:

We are looking for a highly motivated US healthcare process expert to join our team of analytics in US Health Care payment integrity.

We are seeking an experienced and detail-oriented COB Validation Specialist to join our team. The ideal candidate will be responsible for validating coordination of benefits across multiple insurance providers to ensure accurate claims processing and compliance with healthcare regulations.

Responsibilities:

· Validate coordination of benefits (COB) for members with multiple insurance coverage.

· Review and analyze insurance policies to determine the primary and secondary payers.

· Ensure accurate application of COB rules for all submitted claims.

· Collaborate with insurance carriers, providers, and internal teams to resolve discrepancies in billing.

· Identify, investigate, and resolve claim payment issues, including coordination of benefits errors.

· Ensure compliance with all relevant federal, state, and local healthcare regulations.

· Maintain up-to-date knowledge of insurance policies, COB regulations, and industry standards.

· Communicate with internal teams, clients, and external parties to facilitate proper claims resolution.

· Generate and prepare reports related to COB activities, claims issues, and resolutions.

Skillsets:

Must have:

· 4+ yrs. of experience in healthcare claims processing, claims auditing or payment integrity with a minimum of 3 years specifically focused on COB.

· Strong knowledge of COB rules, healthcare insurance claims, and payer systems.

· Experience working with multiple insurance providers and payer systems (Medicare, Medicaid, Commercial Insurance, etc.).

· Familiarity with HIPAA regulations and patient confidentiality.

· Proficiency in Excel, SQL or reporting tools is a plus.

· No RCM, No Accounts Receivable (AR) Callers

Good to Have:

· Understanding of data analytics, statistics, and data management concepts with ability to apply them

· Proven experience working in a fast-paced environment supporting multiple concurrent projects

· Collaborative and team player

o Desire to work within a fast-paced environment

o Ability to work in a team environment and be flexible in taking on various projects