About the Mission of this role:
Claims auditing is a core function of health plan payment integrity operations, but many payment integrity departments lack the ability to track and manage inventory effectively, and others struggle with disparate processes or workflow solutions that require custom builds and integration workarounds into claims platforms.
Our proprietary workflow application, EXLMINE™, is a robust payment integrity system, supporting both pre-payment and post-payment modalities, and is designed to help audit staff to identify, manage, and act on potential improper claims payments. The system improves effectiveness and efficiency by centralizing all functions needed to manage the entire life cycle of an audit from data intake to overpayment recovery to reconciliation and reporting.
EXLMINE™ centralizes all claims audit processes on a single platform, delivering an intelligent experience for claim workflows and inventory management. The EXLMINE™ platform is highly configurable, customizable to meet the demand of any data mining or audit program to support our clients’ business needs.
The Business Analyst is a key role to ensure to ensure requirements are captured to design workflows and provide solutions to internal stakeholders and provide the implement the tools required in EXLMINE.
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