Senior Executive – Audit Operations
Role Overview
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.
The specialist will play a key role in ensuring claims anomalies are accurately and efficiently identified and submitted to the client for recovery of the overpaid claims.
Full Job Posting
Location:
- BangaloreIndia
Qualifications
- Graduation or equivalent (required).
- 4+ years of experience in healthcare and claims adjudication.
- 2+ years of experience in Prepay/Post-pay Payment Integrity, Data Mining or Contract Audit
- Strong understanding of contract rate loading and healthcare payment processing systems, with the ability to interpret and apply complex provider agreements.
- Highly detail-oriented with strong analytical and problem-solving capabilities, especially in identifying payment discrepancies and root causes.
- Proficient in Microsoft Office Suite, particularly Excel (e.g., pivot tables, formulas, VLOOKUP), along with Word and Outlook for documentation and communication.
- Hands-on experience with healthcare claims platforms such as Facets, TriZetto, or similar systems used in US healthcare operations.
- Excellent verbal and written communication skills, enabling effective collaboration with internal teams and external stakeholders.
- Strong organizational and time management skills, with the ability to handle multiple priorities and meet tight deadlines in a dynamic environment.
- BangaloreIndia
Preferred Qualifications
- Knowledge of healthcare reimbursement systems, payer-provider contracts, and claims adjudication processes is a plus.
About Sagility
Providing business process management services for the healthcare industry.
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