EXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visitwww.exlservice.com.
For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change. The business operates within four business units: Insurance, Health, Analytics, and Emerging businesses.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
We are seeking a highly motivated and detailed oriented Claims Analyst to join our team in Hartford, CT. This is a hybrid role (working from home and in our office).
As aClaims Analyst, you will play a critical role by investigating, evaluating and reviewing insurance claims to ensure accurate and timely resolution.
Key Job Role
- Reviewing Adjudicated claims:
- Reviewing claims processing policies and guidelines.
- Reviewing provider contracts.
- Analyzing historical overpayment trends.
- Analyzing claims data to identify outliers.
- Review and access insurance claims to determine coverage, liability and eligibility.
- Validate details such as claim ID, Date of service, refund amount and reason for the overpayment from image.
- Validate claim in system and match all the information from images.
- Conduct thorough investigations, including gathering relevant documentation.
- Collaborate with internal departments, and insurance adjusters to gather necessary information.
- Calculate claims correct payment.
- Maintain detailed and accurate records of claims and related correspondence.
- Assist team members and as and when required.
- Maintain and track overpayment projects in organized and timely manner.
- Adhere to all client and company policies without exceptions.
What you'll need:
- Expertise in US Health Insurance Claims Processing
- Excellent communication skill for client interaction
- Good basic mathematics, reasoning, and interpretation skills
- Working knowledge of MS Excel for project delivery
- Basic understanding of SQL and VBA
- Experience in reporting and data analysis
Preferred Qualifications:
- US Healthcare experience
- Bachelor’s degree and equivalent work experience.
- Minimum 2-3 years’ experience in claims analysis or a related filed.
- Strong analytical and problem-solving skills
- Proficient in using claims management software and tools.
- Knowledge of insurance industry regulations and practices.
- Ability to work independently and as part of a team.
- Detail oriented with a high level of accuracy.
- Strong organizational and time management skills.
- Commitment to maintaining confidentiality and ethical standards.
EEO/Minorities/Females/Vets/Disabilities
To view our total rewards offered click here —> https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer:The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience.The base salary range listed is just one component of EXL's total compensation package for employees.Other rewards may includebonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning– Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
Apply Now
