Senior Executive - Claims Audit

About the role

Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms. Perform manual payment determination and allowable calculations without relying on system tools. Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.

What you'll do

• Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms
• Perform manual payment determination and allowable calculations without relying on system tools
• Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review
• Support data mining programs by providing insights for revenue realization and process improvement
• Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards

What you need

• 20–30 yrs of experience
• Audit
• Claims processing
• Financial statements
• Compliance
• Data analysis
• LLMs
• Any graduate