Quality Analyst – Data Mining, Payment Integrity
EXL United States · $75K–$90K/yr
Business Consulting and Services · 10,001+ employees
About the role
The Quality Analyst ensures the accuracy and consistency of audit findings within the Data Mining program by validating overpayment opportunities and claim repricing. They provide clear feedback to auditors to support performance improvement and ensure alignment with client requirements and coding guidelines.
What they look for
Requirements
Candidates must have at least 5 years of experience in medical claims, healthcare auditing, or related operations, along with a strong understanding of payment methodologies and coding standards. A high school diploma is required, while a college degree and professional coding certifications like CPC are preferred.
Benefits
Full description
The Quality Analyst – Data Mining, Payment Integrity plays a key role in ensuring the accuracy, quality, and consistency of audit work performed within the Data Mining program. This position is responsible for reviewing completed audit findings, validating overpayment opportunities, confirming claim repricing accuracy and supporting documentation, and ensuring audit work aligns with client requirements, coding guidelines, pricing rules, and claim payment methodologies. The ideal candidate brings strong healthcare claims knowledge, analytical thinking, attention to detail, and the ability to provide clear feedback that supports auditor performance, continuous improvement, and stronger recovery outcomes.
Salary Range: $75,000 – $90,000 (based on experience, skills, and qualifications) Location: 100% Remote (U.S.-based)
Up to 10% annual travel (for team meetings and limited client onsite engagements.)
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
