Senior Claims Specialist

2 weeks ago


Hartford, Connecticut, United States ExlService Full time
Position Title: Senior Claims Analyst

Company Overview:
EXL is a prominent global provider of analytics and digital solutions, dedicated to enhancing business performance and fostering growth. We leverage extensive industry knowledge alongside advanced data analytics, cloud technology, and artificial intelligence to deliver flexible, scalable solutions and manage intricate operations for leading firms across various sectors, including insurance, healthcare, banking, and retail.

Core Values:
At EXL, we are committed to innovation, collaboration, excellence, integrity, and respect. Our headquarters are located in New York, and our diverse team comprises over 40,000 professionals across more than 50 offices worldwide.

Role Overview:
We are in search of a detail-oriented and driven Claims Analyst to become a vital part of our team. This role involves a hybrid work model, requiring occasional presence in the office.

Compensation:
Hourly Rate: $17-21/hr

Key Responsibilities:
1. Conduct thorough reviews of adjudicated claims, ensuring compliance with processing policies and guidelines.
2. Analyze provider contracts and historical overpayment trends.
3. Identify outliers in claims data through detailed analysis.
4. Assess insurance claims to determine coverage, liability, and eligibility.
5. Validate claim details, including ID, service dates, refund amounts, and overpayment reasons.
6. Ensure accurate matching of information from documentation.
7. Perform comprehensive investigations, gathering necessary documentation.
8. Collaborate with internal teams and insurance adjusters to obtain relevant information.
9. Calculate correct payment amounts for claims.
10. Maintain precise records of claims and associated correspondence.
11. Support team members as needed and manage overpayment projects efficiently.
12. Adhere strictly to all client and company policies.

Qualifications:
- Expertise in US Health Insurance Claims Processing.
- Strong communication skills for effective client interaction.
- Proficient in basic mathematics and analytical reasoning.
- Familiarity with MS Excel for project management.
- Basic knowledge of SQL and VBA.
- Experience in data reporting and analysis.

Preferred Qualifications:
- Background in US Healthcare.
- Bachelor’s degree or equivalent experience.
- 2-3 years of experience in claims analysis or a related field.
- Strong analytical and problem-solving capabilities.
- Proficient in claims management software.
- Understanding of insurance industry regulations.
- Ability to work independently and collaboratively.
- Detail-oriented with a commitment to accuracy.
- Excellent organizational and time management skills.
- Commitment to confidentiality and ethical standards.

Equal Employment Opportunity:
EXL is an equal opportunity employer and values diversity in the workplace.

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