Senior Executive – Audit Operations

About the role

The Senior Executive will be responsible for ensuring accurate identification of a clients claim payment anomalies by obtaining the clients provider agreements and contract loading, researching and flagging discrepancies, and validating claims for payment integrity. This role involves collaborating with various departments, using system tools to load contracts, identify claim anomalies, and ensure compliance with healthcare regulations and company policies.

What you'll do

• Accurately load, configure, and maintain healthcare provider contracts within the audit and claims systems, ensuring alignment with contractual terms
• Review and update contract details including fee schedules, reimbursement rates, and payment terms to support accurate claims adjudication
• Ensure timely and precise updates to contract data, reflecting the most current agreement terms and minimizing payment discrepancies
• Review claims flagged by the audit system as potentially overpaid to confirm validity and ensure they meet overpayment criteria
• Identify and flag claims that appear non-compliant with contract terms, benefit rules, or established payment policies

What you need

• 4–7 yrs of experience
• Audit
• Claims processing
• Excel
• Reporting
• Compliance
• Data analysis
• Any graduate