Auditor II - Data Mining

The Auditor II - DM (Data Mining) reviews the output of queries to identify potential overpayments and performs the audit following set internal policies and procedures in accordance with the regulations and set contractual agreements between insurers and providers. Exercises independent decision making and professional judgment, using medical claims knowledge on a regular basis. The Auditor I determines if a discrepancy exists and documents the findings using standard documentation guidelines as applicable.

• Base Pay Range: $18.50 - $30.00/hr

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.

Attention to Detail

Excellent written and oral communication skills

Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities

Must be able to learn, understand, and apply new technologies

Knowledge CMS guidelines

Strong knowledge of HCPC, CPT and other coding methodologies

Spreadsheet, word processing, and database knowledge

Educational Qualifications:

High School Diploma or Equivalent Required

College Degree or Equivalent Work Experience

Maintain OIG/GSA clearances

Preferred Experience:

1-2 Years' Experience Auditor

1-2 Years' Experience with Medical Claims Processing

• The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate''s skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

Reviews output of queries for overpayments.

Follow Query Step-by-Step Documentation to validate overpayments.

If available, utilize claims system(s) to verify overpayments.

Document overpayments/non overpayments in production systems. Claims not overpaid should have clear reasons articulated for research purposes and quality assurance.

Meet quality and production standards.

Record production tasks and time into format outlined by Management.

Communicate to Management any issue(s) that would impede completion of assigned work.

Work with Management to ensure these issues are resolved.

Provide feedback to Management on areas of improvement.

Reviews output of queries for overpayments.

Follow Query Step-by-Step Documentation to validate overpayments.

If available, utilize claims system(s) to verify overpayments.

Document overpayments/non overpayments in production systems. Claims not overpaid should have clear reasons articulated for research purposes and quality assurance.

Meet quality and production standards.

Record production tasks and time into format outlined by Management.

Communicate to Management any issue(s) that would impede completion of assigned work.

Work with Management to ensure these issues are resolved.

Provide feedback to Management on areas of improvement.