- Job Role: Auditors-Datamining
- Experience (In Years): 9-12
- Job Location: Hyderabad, Telangana, India
Working Hours:
Full-time role (40 hours/week).
Shift: 08:00 AM – 05:00 PM IST (subject to change based on project requirements).
Weekends: Off (may vary based on business needs).
Telecommuter/Internet requirements, if applicable:
High Speed internet connection at home must be broadband.
Must understand and adhere with telecommuter policy
Responsibilities
Skills and abilities:
- Should have a good understanding of the US healthcare system and management.
- Should have thorough understanding of healthcare payer analytics specifically the business model for datamining operations.
- Preferably candidates should have work experience in the data mining Medicare or Commercial line of business.
- Should have thorough understanding of the payer system loopholes in the claims cost management.
- Should be able to think beyond horizon as ways to clog in those gaps for realizing higher revenue for datamining program.
- Will be responsible for auditing claims on Medicare or Commercial business based various data mining concepts to find overpayments.
- Will be responsible for bringing in new idea to refine concept to remove false positive
- The position is purely metrics and target driven in the perspective of claim audits to initiate overpayment that exist in deployed data mining concepts.
- The position will be strictly evaluated based on the accuracy over claim audits and overpayments identification
- Should possess a strong interpersonal skill set to be able to work well with other people/teams, including in teams or groups, formally and informally.
- Should be able to work independently with minimal guidance.
- Should be purely data and metrics driven person and discuss with Manager on a regular basis on the program/individual.
Qualifications
Experience:
Claims Adjudication experience: Minimum 9 years
Overpayment experience.
Prefer candidates with experience in Post adjudication/overpayment projects.
Qualification:
Graduation is mandatory.
