Company Overview and Culture 

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, visit www.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.

EXL Health is looking for a Payment Integrity Claims Resolution and Contract Analyst. This is 100% remote work from home opportunity!

Are you experienced in Payment Integrity Audit Collections and Payer Provider Contracts looking for the next step in your career path? Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this role you will collaborate with Payment Integrity Audit program leaders, key client team members, and reporting team members to perform aged claim reconciliation, daily payment verification processing and inventory management.  This role will also abstract information from payer provider contracts and abstract contractual reimbursement terms to build and maintain a Provider Matrix which will support client specific audit & recovery opportunities.  The successful candidate will be passionate, quality focused and have a diverse background in payment integrity audits.

Responsibilities:

• Research audit inventory for aged claim invoicing and collections
• Reconciliation of post audit inventory and reporting
• Daily payment verification processing and reporting
• Identify and assist with implementing process enhancements
• Analyze payer provider contracts to abstract payment terms/requirements to support Payment Integrity audit programs
• Access client’s claim systems to validate claim reimbursement terms
• Maintain a payer/provider matrix

Qualifications:

• 5 years of experience in Payment Integrity Audit Collections
• 5 years or equivalent work experience in healthcare managed care contracts

• Strong analytical skills, with attention to details and ability to problem solve
• Attention to detail and ability to problem solve
• Excellent computer skills with a strong proficiency in excel, word, and outlook

Education and Required Certification:

• Bachelor’s degree or equivalent work experience in payment integrity services

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.