Qureos Mentor

EXL Service

<div><p>Job Description: EXL USA Healthcare is seeking an IRF Auditor III to join our team. This role offers a fully remote work experience with possible 10% travel per year for team meetings and limited client onsite engagements. The rest of the time, you will enjoy the flexibility of working from your home office.
</p><div><p><div><div><div><div><p><b>Salary Range
</b><br>
$70,000 - $110,000
<br>
Based on experience, skills, and qualifications<br>
</p></div><div><p><b>Location
</b><br>
100% Remote
<br>
U.S.-based<br>
</p></div><div><p><b>Travel
</b><br>
Up to 10% Annual Travel
<br>
Team meetings and limited client onsite engagements
</p></div></div><br>
</div></div></p></div><p><b>A brief coding/auditing assessment may be included as part of the interview process.
</b></p><p>For more information on benefits and what we offer, please visit: https://www.exlservice.com/us-careers-and-benefits
</p><p>The posted range is the hiring range for this role - a subset of the broader range available to employees over time - and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
</p><p><b>Why EXL?
</b></p><p>At EXL, we believe in fostering an environment where employees can learn, grow, and succeed. We provide industry-leading training, career development opportunities, and a competitive benefits package so you can focus on delivering excellence in IRF payment integrity auditing. If you are looking for a role where your expertise can make a real impact while maintaining work-life balance, this is it!</p></div>
<br><div><p><b>Responsibilities: What You&rsquo;ll Do:
</b></p><ul><li><p>Conduct comprehensive IRF payment integrity audits using the IRF-PAI, UB-04/final bill, acute inpatient discharge summary, complete IRF medical record, therapy documentation, physician orders and notes, nursing notes, MAR, history and physical, pre-admission screening, individualized overall plan of care, and interdisciplinary team documentation.
</p></li><li><p>Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, date of onset, comorbid conditions, and complication/comorbidity reporting, based on client requirements and applicable CMS/IRF-PAI guidance.
</p></li><li><p>Identify documentation, coding, and reimbursement discrepancies that may impact IRF payment, including unsupported diagnoses, comorbidities not treated or not clinically supported during the IRF stay, or diagnoses carried forward from the prior acute inpatient stay without IRF-level support.
</p></li><li><p>Review client payment methodology and contract requirements where applicable, including IRF PPS/HIPPS, per diem, Medicare Advantage, Medicaid, and commercial reimbursement variations.
</p></li><li><p>Craft clear, concise, and well-supported audit findings that explain the documentation reviewed, the rationale for the finding, and the financial/reimbursement impact.
</p></li><li><p>Collaborate with clinical SMEs, nurses, physicians, analytics, and client-facing teams when audit scope includes medical necessity, contract interpretation, selection logic, or payer-specific requirements.
</p></li><li><p>Manage complex and lengthy IRF records with strong attention to detail, ensuring all relevant therapy, nursing, physician, and interdisciplinary documentation is considered before finalizing findings.
</p></li><li><p>Meet or exceed EXL quality and productivity standards while maintaining strong defensibility of audit findings and appeal outcomes.
</p></li><li><p>Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manual updates, ICD-10-CM/PCS coding updates, and payer-specific policy changes.
</p></li><li><p>Adhere to HIPAA, information security, and EXL policies and procedures to ensure data security and regulatory compliance.</p></li></ul></div>
<br><div><p><b>Qualifications: What We&rsquo;re Looking For:
</b></p><p><b>Education &amp; Credentials:
</b></p><ul><li><p>Minimum High School Diploma required; higher education preferred.
</p></li><li><p>CCS, RHIA, RHIT, CIC, or CPC credential preferred; multiple credentials strongly preferred.
</p></li><li><p>Clinical licensure or rehabilitation facility experience is a plus when client scope includes medical necessity review.
</p></li></ul><p><b>Experience &amp; Expertise:
</b></p><ul><li><p>4+ years of inpatient facility coding, auditing, payment integrity, or reimbursement review experience.
</p></li><li><p>Prior experience with IRF audits, IRF-PAI review, IRF PPS/HIPPS methodology, rehabilitation facility documentation, or inpatient rehabilitation reimbursement is highly desirable.
</p></li><li><p>Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, and payer reimbursement methodologies.
</p></li><li><p>Experience reviewing lengthy medical records and tying documentation to reimbursement impact, treatment during the IRF stay, and payer/client requirements.
</p></li></ul><p><b>Key Skills &amp; Attributes:
</b></p><ul><li><p>Expert-level inpatient auditing mindset with the ability to distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic.
</p></li><li><p>Strong analytical, problem-solving, and critical-thinking skills with excellent attention to detail.
</p></li><li><p>Self-motivated and able to work independently in a remote environment while maintaining high quality and productivity.
</p></li><li><p>Strong written and verbal communication skills, including the ability to write clear audit rationale and collaborate with internal/client stakeholders.
</p></li><li><p>Proficient in Excel, Word, OneNote, and general computer literacy; experience with audit workflow tools and encoder/reference tools preferred.
</p></li><li><p>Commitment to teamwork, collaboration, continuous learning, and defensible audit outcomes.
</p></li></ul><p><b>Required Skills
</b></p><div><p><div><div><div><div><p>Inpatient Rehabilitation Facility (IRF)<br>
</p></div><div><p>IRF-PAI<br>
</p></div><div><p>IRF PPS / HIPPS Methodology<br>
</p></div></div><br>
<div><div><p>ICD-10-CM/PCS<br>
</p></div><div><p>Medical Record Review<br>
</p></div><div><p>Payment Integrity Auditing<br>
</p></div></div><br>
<div><div><p>Reimbursement Methodology<br>
</p></div><div><p>Documentation Validation<br>
</p></div><div><p>Audit Findings Writing<br>
</p></div></div><br>
<div><div><p>Attention to Detail<br>
</p></div><div><p>Computer Literacy<br>
</p></div><div><p>Microsoft Office<br>
</p></div></div><br>
<div><div><p>Internal Communications<br>
</p></div><div><p>Interpersonal Relationship Building<br>
</p></div><div><p>Working Under Pressure
</p></div></div><br>
</div></div></p></div><p><b>What We Offer
</b></p><ul><li><p>A fast-paced, innovative environment with a team of industry-leading experts.
</p></li><li><p>Hands-on experience with top-tier clients in the healthcare industry.
</p></li><li><p>Mentorship and career development programs to help you grow professionally.
</p></li><li><p>A strong culture of collaboration, support, and inclusivity.
</p></li><li><p>Competitive benefits package, including healthcare, vision, dental, and 401(k) options.
</p></li></ul><p>Ready to Take Your Career to the Next Level?
</p><p>If you are looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference, apply today and become part of the EXL team!
</p><p><b>About Us
</b></p><p>EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world&rsquo;s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. For more information, visit www.exlservice.com.
</p><p>EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL&rsquo;s Human Resources team, as well as our hiring managers.</p></div>

Diagnosis Related Group (DRG) / Inpatient Rehabilitation Facility (IRF) Auditor

<div><p><b>Job Description: We are seeking an experienced Lead Data Engineer to support complex data engineering initiatives within our insurance data and analytics practice. This role combines deep technical expertise with strong coordination skills, working closely with onshore and offshore teams, business stakeholders, and project leadership to deliver enterprise data modernization and migration programs. The candidate will serve as a technical point of contact for cross-functional teams while remaining hands-on with cloud data technologies.
</b></p><p>Base Compensation Range: 90,000 &ndash; 140,000
</p><p>The posted range is the hiring range for this role &mdash; a subset of the broader range available to employees over time &mdash; and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
</p><p>For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits</p></div>
<br><div><p><b>Responsibilities: Technical Delivery
</b></p><ul><li>Design and implement end-to-end data pipelines using PySpark, Snowflake, and AWS cloud services
</li><li>Architect scalable ELT/ETL workflows and data warehouse models supporting insurance analytics use cases
</li><li>Drive data migration and modernization efforts from legacy environments to cloud-native platforms
</li><li>Develop and review complex SQL transformations, stored procedures, and data quality validation frameworks
</li><li>Establish and enforce data engineering standards, coding best practices, and pipeline documentation
</li><li>Provide hands-on troubleshooting and performance optimization across the data stack
</li></ul><p><b>Team Coordination &amp; Stakeholder Engagement
</b></p><ul><li>Coordinate day-to-day activities across onshore and offshore data engineering teams to ensure timely delivery
</li><li>Serve as a technical point of contact for business stakeholders, translating requirements into engineering deliverables
</li><li>Facilitate requirement-gathering sessions, sprint planning, and status updates with project teams
</li><li>Communicate project progress, risks, and dependencies to project managers and client stakeholders
</li><li>Mentor junior engineers and conduct code reviews to uphold quality standards
</li><li>Collaborate with data architects, analysts, and QA teams throughout the project lifecycle
</li></ul><div><p><b>Required Skills &amp; Qualifications
</b></p></div><p><b>Technical Skills
</b></p><ul><li>Deep experience with Snowflake including data modeling, performance tuning
</li><li>Proficiency with AWS services &mdash; S3, Glue, Lambda, EMR, Redshift, Step Functions, CloudWatch
</li><li>Strong experience building distributed data processing frameworks with Apache Spark / PySpark
</li><li>Advanced SQL skills &mdash; complex transformations, query optimization, and dimensional modeling
</li><li>Expertise in DWH design patterns &mdash; Kimball, Inmon, Data Vault, star and snowflake schemas
</li><li>Demonstrated experience leading or contributing to cloud migration and legacy modernization programs
</li><li>Familiarity with tools such as dbt, Apache Airflow, AWS Glue, or similar orchestration frameworks
</li><li>Solid Python programming for data engineering and automation tasks
</li></ul><p><b>Experience Requirements
</b></p><ul><li>6&ndash;9 years of progressive experience in data engineering
</li><li>Prior experience in insurance, financial services, or regulated industries preferred
</li><li>Experience coordinating distributed teams across time zones (onshore/offshore model)
</li><li>Demonstrated ability to engage with non-technical stakeholders and translate business requirements
</li></ul><p>Exposure to Agile/Scrum delivery methodology</p></div>
<br><p></p><div><ul><li>Qualifications: Bachelor's degree in Computer Science, Information Systems, Engineering, or a related field</li></ul></div><p></p>

Lead Data Engineer

<div><p><b>Job Description: Work Location: United States
</b><br>
<b>Work Mode : Remote
</b><br>
<b>Pay Range :$125K-$130K /Yr Base + Annual Bonus
 </b></p><p><i>The posted range is the hiring range for this role &mdash; a subset of the broader range available to employees over time &mdash; and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process
</i></p><p>For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits<br>
</p><p></p><p><b>Job Overview:
</b></p><p>As an FP&amp;A Manager, GTM Finance &mdash; Credit Products, you will focus on the credit business by partnering with Sales, Legal, Product, Credit Risk, and Capital Markets to model pricing, evaluate profitability, and structure deals that win business while protecting unit economics. You'll flex in on debit and prepaid as needed, but credit is where you'll spend the majority of your time.</p></div>
<br><div><ul><li>Responsibilities: Serve as the financial partner to Sales on live credit deals &mdash; modeling the full economic stack: interchange, finance charges, fees, rewards costs, cost of funds, expected losses, network fees, and sponsor bank revenue share
</li><li>Build deal-level models that capture the full life-of-portfolio economics &mdash; not just first-year interchange, but how the deal performs as the portfolio matures, revolve rates stabilize, and losses curve in
</li><li>Partner with Credit Risk and Capital Markets teams to make sure every deal model reflects realistic loss assumptions, funding costs, and capital efficiency considerations
</li><li>Partner with the credit function to build the foundational models for credit product including monthly projections of volumes, receivables, payment rates and loss curves with clearly defined assumptions for each metric and tied to actual industry and internal data, including scenario analyses that support acquiring both new bank partnerships (sponsor banks) and capital providers (warehouse facilities, return-on-capital projections, portfolio performance scenarios)
</li><li>Model multi-party revenue share structures across program manager, sponsor bank, processor, and network &mdash; and stress-test how the splits behave at different volume and performance tiers
</li><li>Lead deal review meetings on credit deals with sales leadership, translating complex credit economics into clear, actionable recommendations that help close business without compromising margin
</li><li>Build and continuously sharpen the credit-specific deal desk toolkit &mdash; pricing benchmarks, loss-curve templates, capital-cost calculators, vintage performance models, and the dashboards that bring them together
</li><li>Help Sales speak credibly about credit economics with prospects &mdash; from sophisticated fintech buyers building their second card program, to commercial customers thinking about a credit product for the first time
</li><li>Stay close to credit product evolution, regulatory developments (Reg Z, CFPB, state usury), and competitive dynamics in the credit issuing space &mdash; and bring that intelligence into every deal
</li><li>Collaborate closely with the rest of the deal desk team across debit, prepaid, and other product lines &mdash; flexing in on those deals when the team needs the bandwidth, sharing knowledge, covering each other on big deals, and raising the bar together
</li><li>Experiment with AI to make credit deal modeling faster and better &mdash; whether that's automating portfolio projection models, accelerating scenario analysis, or building internal tools that scale your judgment across more deals</li></ul></div>
<br><div><ul><li>Qualifications: Bachelor's degree in a quantitative field &mdash; Finance, Accounting, Economics, Engineering, Math, or any discipline that built your numerical fluency
</li><li>6-8 years of experience in financial planning and analysis, deal desk, pricing, credit product finance, or a related GTM finance function &mdash; with meaningful exposure to credit card or lending economics</li></ul></div>

FP&A Manager, GTM Finance - Credit Products

<div><p>Job Description: EXL Service is seeking an accomplished Senior Databricks Data Engineer with 10&ndash;12 years of experience designing, developing, and optimizing enterprise data platforms and large-scale ETL solutions. The ideal candidate brings deep expertise in Databricks, Spark, Delta Lake, Azure Data Platform, and modern data engineering practices.
</p><p>This role is responsible for building scalable data pipelines, implementing cloud-native data solutions, improving platform performance, and delivering reliable data products for analytics, reporting, and AI/ML initiatives.
</p><p>Base Compensation Range: 65,000 &ndash; 87,000
</p><p>The posted range is the hiring range for this role &mdash; a subset of the broader range available to employees over time &mdash; and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
</p><p>For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits</p></div><p></p>
<br><div><p>Responsibilities: Key Responsibilities
</p><p>Data Engineering &amp; Platform Development
</p><ul><li>Design, develop, and optimize enterprise-scale data pipelines using Databricks, Spark, Delta Lake, and Azure Data Lake Storage.
</li><li>Build batch and incremental ETL/ELT pipelines, real-time streaming architectures, and reusable data integration frameworks.
</li><li>Develop scalable ingestion frameworks supporting structured, semi-structured, and API-based data sources.
</li><li>Build reusable data engineering frameworks for ingestion, transformation, validation, reconciliation, and publishing.
</li><li>Develop Delta Lake solutions using partitioning, optimization, Z-Ordering, Liquid Clustering, and performance tuning techniques.
</li><li>Implement CDC, incremental processing, merge strategies, and data synchronization across enterprise platforms.
</li><li>Develop Databricks Workflows, notebooks, SQL Jobs, and automation for production workloads.
</li><li>Integrate external REST APIs and process JSON/XML data into analytics-ready datasets.
</li><li>Implement robust data quality checks, audit frameworks, monitoring, and error handling.
</li>Optimize Spark jobs for performance, scalability, and cost efficiency.<br>
<li>
</li></ul><p></p><p>Databricks &amp; Azure Development
</p><ul><li>Develop solutions using Azure Data Lake Storage Gen2, Databricks, Unity Catalog, Azure Key Vault, Azure DevOps, and Azure Synapse.
</li><li>Build secure data pipelines using Unity Catalog, RBAC, service principals, and managed identities.
</li><li>Develop reusable notebook frameworks using PySpark and Spark SQL.
</li><li>Implement CI/CD deployment pipelines using Azure DevOps.
</li><li>Manage environment promotion across Development, QA, UAT, and Production.
</li>Troubleshoot production issues and optimize workloads for reliability and scalability.<br>
<li>
</li></ul><p></p><p>Data Integration &amp; Analytics
</p><ul><li>Design enterprise data models supporting reporting, analytics, and downstream applications.
</li><li>Develop healthcare and financial data integration pipelines supporting multiple source systems.
</li><li>Build reusable metadata-driven ETL frameworks.
</li><li>Integrate third-party APIs including NLP, terminology normalization, and identity resolution services.
</li><li>Support data governance, lineage, and metadata management initiatives.</li></ul></div><p></p>
<br><div><p>Qualifications: Required Skills &amp; Experience
</p><p>Technical Expertise
</p><ul><li>10-12 years of experience in Data Engineering, ETL Development, and Data Warehousing.
</li><li>Hands-on Databricks development experience.
</li><li>Strong experience with Spark, Delta Lake, Unity Catalog, Databricks Workflows, and SQL Warehouses.
</li><li>Strong experience with PySpark, Spark SQL, SQL, and Python.
</li><li>Experience building enterprise ETL/ELT pipelines using Databricks and Azure Data Platform.
</li><li>Experience with Azure Data Lake Storage (ADLS Gen2), Azure Synapse, Azure Key Vault, and Azure DevOps.
</li><li>Experience implementing CDC, SCD, incremental loading, and data quality frameworks.
</li><li>Experience integrating REST APIs and processing JSON/XML datasets.
</li><li>Experience with Git, CI/CD, release management, and deployment automation.
</li><li>Strong knowledge of performance tuning, partitioning, caching, broadcast joins, and Spark optimization.
</li><li>Experience working with healthcare data platforms is preferred.
</li><li>Microsoft Azure certifications (e.g., DP-203 Azure Data Engineer Associate) or Databricks certifications (Data Engineer Associate/Professional).
</li><li>Experience with Ab Initio suite of products is also preferred.</li></ul></div>

Databricks Data Engineer

<div><p>Job Description: Scrum Master &ndash; Job Description
</p><p><b>Experience: </b>7&ndash;10 Years
</p><p>Seeking an experienced Scrum Master to drive Agile delivery across two parallel Full Stack Development teams &mdash; facilitating ceremonies, managing cross-team dependencies, and ensuring predictable, high-quality sprint delivery.<br>
</p><p></p><p>Must-Have Roles &amp; Responsibilities
</p><ul><li>Facilitate all Scrum ceremonies (Planning, Stand-ups, Reviews, Retrospectives, Refinement) for two teams running parallel sprints.
</li><li>Synchronize sprint cadences and release planning across both teams; manage cross-team dependencies.
</li><li>Proactively identify and remove impediments, risks, and blockers with clear escalation paths.
</li><li>Track and report Agile metrics &mdash; velocity, burndown, cycle time, sprint predictability &mdash; to stakeholders.
</li><li>Partner with Product Owners to maintain a healthy, refined backlog (2&ndash;3 sprints ahead) for both teams.
</li><li>Coach teams toward self-organization and continuous improvement; drive retrospective actions to closure.
</li><li>Shield teams from scope churn; manage stakeholder expectations on scope and timelines.
</li><li>Administer Jira/Azure DevOps boards, dashboards, and reports; enforce DoR/DoD and story hygiene.
</li></ul><p>Must-Have Skills
</p><ul><li>7&ndash;10 years IT experience with <b>5+ years as a Scrum Master </b>, handling <b>2+ concurrent Agile teams </b>.
</li><li>Strong SDLC understanding of full stack development (front-end, back-end, APIs, CI/CD).
</li><li><b>CSM or PSM certification (mandatory) </b>; expert in Jira/Azure DevOps.
</li><li>Proven cross-team dependency and release coordination skills.
</li><li>Excellent facilitation, conflict-resolution, and stakeholder-management skills.
</li></ul><p>Good-to-Have
</p><ul><li>SAFe/scaled Agile experience, Kanban, prior technical background, PMI-ACP.
</li></ul><p>Base Compensation Range: $100,000.00&ndash; $110,000
</p><p>The posted range is the hiring range for this role &mdash; a subset of the broader range available to employees over time &mdash; and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.</p></div><p></p>
<br><div>Responsibilities: Must-Have Skills
<ul><li>7&ndash;10 years IT experience with <b>5+ years as a Scrum Master </b>, handling <b>2+ concurrent Agile teams </b>.
</li><li>Strong SDLC understanding of full stack development (front-end, back-end, APIs, CI/CD).
</li><li><b>CSM or PSM certification (mandatory) </b>; expert in Jira/Azure DevOps.
</li><li>Proven cross-team dependency and release coordination skills.
</li><li>Excellent facilitation, conflict-resolution, and stakeholder-management skills.</li></ul></div>
<br><div><p>Qualifications: 7&ndash;10 years IT experience with 5+ years as a Scrum Master , handling 2+ concurrent Agile teams .</p></div>

Scrum Master

<div><p>Job Description: In this fully remote position as an HCD Auditor you will apply your expert knowledge of billing HCD claims to perform extensive audit reviews. You will utilize HCPCS codes, medical record review, industry and EXL proprietary tools in the audit process. Write professional communications documenting audit findings and supporting rationales. You will also apply your extensive industry knowledge to identify audit trends and opportunities.
</p><p><b>Salary range $55,000.00-$70,000.00
</b></p><p><b>0-10% travel may be required.
</b></p><p><b>For more information on benefits and what we offer please visit us at </b>https://www.exlservice.com/us-careers-and-benefits</p></div>
<br><div><ul><li>Responsibilities: Conduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on high cost drug professional and outpatient facility claims.
</li><li>Apply complex medical record reviews to identify discrepancies between physician orders, nursing administration logs, and final claims submissions.
</li><li>Apply Medicare, Medicaid, and commercial guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
</li><li>Document audit results in a clear, concise, and effective manner using AMA Guidelines.
</li><li>Utilize proprietary workflow systems to make audit determinations, generate audit rationales, and move claims through workflow process correctly efficiently and accurately.
</li><li>Accurately reprice complex claims utilizing multiple client claims systems.
</li><li>Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
</li><li>Research prescribed drug dosage and related conditions to ensure appropriateness of medical guidelines and accuracy of reimbursement.
</li><li>Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.</li></ul></div>
<br><div><p><b>Qualifications: Required Qualifications
</b></p><ul><li>Three or more years' experience in claims processing or HCD medical billing experience with expert knowledge HCPCS codes.
</li><li>Experience reading and interpreting contract language and fee schedules and medical record review.
</li><li>Intermediate skills in Word and basic computer literacy.
</li><li>Intermediate skills in Excel including comfort working with charts, graphs, and percentages.
</li><li>Basic math skills with ability to do conversion calculations.
</li><li>High school diploma obtained
</li></ul><p><b>Preferred Qualifications
</b></p><ul><li>Certified Pharmacy Technician or one or more of the following credentials: RHIA or CPC; preference given to those with multiple credentials.
</li><li>Expert in HCPCS codes with advanced knowledge of medical terminology.
</li><li>Experience with encoder tools and industry systems (FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers).
</li></ul><p><b>Professional Qualifications
</b></p><ul><li>Works independently in a remote environment and delivers exceptional results during EXL core business hours.
</li><li>Possesses excellent time management and work prioritization skills.
</li><li>Takes ownership of problem solving.
</li><li>Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
</li><li>Enthusiastic about Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.</li></ul></div>

High Cost Drug Auditor III

<div><p><b>Job Description: Key Responsibilities
</b></p><ul><li>Design and develop <b>LLM-based applications </b>using single-agent or simple multi-agent patterns for business use cases
</li><li>Build and maintain <b>RAG pipelines </b>: data ingestion chunking embeddings retrieval response generation
</li><li>Implement <b>prompt engineering techniques </b>(prompt templates, chaining, basic tool/function calling)
</li><li>Develop backend services/APIs for AI applications using <b>Python frameworks (FastAPI / Flask / Streamlit)
</b></li><li>Integrate AI solutions with enterprise systems, databases, and APIs
</li><li>Apply basic <b>guardrails and validation checks </b>to improve response quality and reduce hallucination
</li><li>Work with Data Engineering teams to ensure <b>data quality, pipeline efficiency, and proper documentation
</b></li><li>Collaborate with MLOps teams for <b>deployment, monitoring, and iterative improvements
</b></li>Document solutions, reusable components, and best practices<br>
<li>
</li></ul><div></div><p><b>Must-Have Skills
</b></p><p><b>Experience
</b></p><ul><li><b>4&ndash;6 years total experience </b>, with <b>1+ year hands-on experience in GenAI / LLM-based applications<br>
</b></li></ul><div></div><p><b>LLM / GenAI &amp; Agentic Engineering
</b></p><ul><li>Strong hands-on experience with:
<ul><li>LLMs (Claude, OpenAI, etc.)
</li><li>RAG pipelines and retrieval optimisation
</li><li>GPT + Agentic AI implementation experience
</li></ul></li><li>Experience with:
<ul><li>LangChain, LangGraph, or similar frameworks
</li><li>Agent orchestration and tool-calling architectures
</li></ul></li>Deep understanding of:
LLM limitations, evaluation, and optimisation strategies<br>
<li><ul><li>
</li></ul></li></ul><div></div><p><b>Core Engineering
</b></p><ul><li>Strong Python/Pyspark engineering expertise (production-grade development) with proven API integration experience
</li><li>Deep data analysis experience and handling large volume of data
</li><li>Fabric/Azure Databricks/Snowflake data engineering integration skills
</li><li>Good exposure to:
<ul><li>Cloud platforms (Azure/AWS/GCP)
</li><li>SQL
</li>Containers, CI/CD, monitoring<br>
<li>
</li></ul></li></ul><div></div><p><b>Data / AI Foundations (Mandatory)
</b></p><p>Prior experience in one or more:
</p><ul><li>Data Engineering (ETL/ELT, pipelines, orchestration)
</li><li>Data Science / ML lifecycle (especially NLP)
</li>Analytics engineering / data products<br>
<li>
</li></ul><div></div><p><b>Good-to-Have / Preferred
</b></p><ul><li>Exposure to <b>model fine-tuning (LoRA/PEFT) or prompt optimisation techniques
</b></li><li>Experience with <b>evaluation of LLM outputs (quality, relevance, latency)
</b></li><li>Understanding of <b>enterprise data privacy and security considerations in GenAI
</b></li><li>Exposure to <b>Azure AI / Azure OpenAI / AI Search ecosystems
</b></li><li>Experience working on <b>real client-facing AI solutions or POCs</b></li></ul></div><div></div>
<br><div><p><b>Responsibilities: Key Responsibilities
</b></p><ul><li>Design and develop <b>LLM-based applications </b>using single-agent or simple multi-agent patterns for business use cases
</li><li>Build and maintain <b>RAG pipelines </b>: data ingestion chunking embeddings retrieval response generation
</li><li>Implement <b>prompt engineering techniques </b>(prompt templates, chaining, basic tool/function calling)
</li><li>Develop backend services/APIs for AI applications using <b>Python frameworks (FastAPI / Flask / Streamlit)
</b></li><li>Integrate AI solutions with enterprise systems, databases, and APIs
</li><li>Apply basic <b>guardrails and validation checks </b>to improve response quality and reduce hallucination
</li><li>Work with Data Engineering teams to ensure <b>data quality, pipeline efficiency, and proper documentation
</b></li><li>Collaborate with MLOps teams for <b>deployment, monitoring, and iterative improvements
</b></li>Document solutions, reusable components, and best practices<br>
<li>
</li></ul><div></div><p><b>Must-Have Skills
</b></p><p><b>Experience
</b></p><ul><li><b>4&ndash;6 years total experience </b>, with <b>1+ year hands-on experience in GenAI / LLM-based applications<br>
</b></li></ul><div></div><p><b>LLM / GenAI &amp; Agentic Engineering
</b></p><ul><li>Strong hands-on experience with:
<ul><li>LLMs (Claude, OpenAI, etc.)
</li><li>RAG pipelines and retrieval optimisation
</li><li>GPT + Agentic AI implementation experience
</li></ul></li><li>Experience with:
<ul><li>LangChain, LangGraph, or similar frameworks
</li><li>Agent orchestration and tool-calling architectures
</li></ul></li>Deep understanding of:
LLM limitations, evaluation, and optimisation strategies<br>
<li><ul><li>
</li></ul></li></ul><div></div><p><b>Core Engineering
</b></p><ul><li>Strong Python/Pyspark engineering expertise (production-grade development) with proven API integration experience
</li><li>Deep data analysis experience and handling large volume of data
</li><li>Fabric/Azure Databricks/Snowflake data engineering integration skills
</li><li>Good exposure to:
<ul><li>Cloud platforms (Azure/AWS/GCP)
</li><li>SQL
</li>Containers, CI/CD, monitoring<br>
<li>
</li></ul></li></ul><div></div><p><b>Data / AI Foundations (Mandatory)
</b></p><p>Prior experience in one or more:
</p><ul><li>Data Engineering (ETL/ELT, pipelines, orchestration)
</li><li>Data Science / ML lifecycle (especially NLP)
</li>Analytics engineering / data products<br>
<li>
</li></ul><div></div><p><b>Good-to-Have / Preferred
</b></p><ul><li>Exposure to <b>model fine-tuning (LoRA/PEFT) or prompt optimisation techniques
</b></li><li>Experience with <b>evaluation of LLM outputs (quality, relevance, latency)
</b></li><li>Understanding of <b>enterprise data privacy and security considerations in GenAI
</b></li><li>Exposure to <b>Azure AI / Azure OpenAI / AI Search ecosystems
</b></li><li>Experience working on <b>real client-facing AI solutions or POCs</b></li></ul></div><div></div>
<br><div><p><b>Qualifications: Key Responsibilities
</b></p><ul><li>Design and develop <b>LLM-based applications </b>using single-agent or simple multi-agent patterns for business use cases
</li><li>Build and maintain <b>RAG pipelines </b>: data ingestion chunking embeddings retrieval response generation
</li><li>Implement <b>prompt engineering techniques </b>(prompt templates, chaining, basic tool/function calling)
</li><li>Develop backend services/APIs for AI applications using <b>Python frameworks (FastAPI / Flask / Streamlit)
</b></li><li>Integrate AI solutions with enterprise systems, databases, and APIs
</li><li>Apply basic <b>guardrails and validation checks </b>to improve response quality and reduce hallucination
</li><li>Work with Data Engineering teams to ensure <b>data quality, pipeline efficiency, and proper documentation
</b></li><li>Collaborate with MLOps teams for <b>deployment, monitoring, and iterative improvements
</b></li>Document solutions, reusable components, and best practices<br>
<li>
</li></ul><div></div><p><b>Must-Have Skills
</b></p><p><b>Experience
</b></p><ul><li><b>4&ndash;6 years total experience </b>, with <b>1+ year hands-on experience in GenAI / LLM-based applications<br>
</b></li></ul><div></div><p><b>LLM / GenAI &amp; Agentic Engineering
</b></p><ul><li>Strong hands-on experience with:
<ul><li>LLMs (Claude, OpenAI, etc.)
</li><li>RAG pipelines and retrieval optimisation
</li><li>GPT + Agentic AI implementation experience
</li></ul></li><li>Experience with:
<ul><li>LangChain, LangGraph, or similar frameworks
</li><li>Agent orchestration and tool-calling architectures
</li></ul></li>Deep understanding of:
LLM limitations, evaluation, and optimisation strategies<br>
<li><ul><li>
</li></ul></li></ul><div></div><p><b>Core Engineering
</b></p><ul><li>Strong Python/Pyspark engineering expertise (production-grade development) with proven API integration experience
</li><li>Deep data analysis experience and handling large volume of data
</li><li>Fabric/Azure Databricks/Snowflake data engineering integration skills
</li><li>Good exposure to:
<ul><li>Cloud platforms (Azure/AWS/GCP)
</li><li>SQL
</li>Containers, CI/CD, monitoring<br>
<li>
</li></ul></li></ul><div></div><p><b>Data / AI Foundations (Mandatory)
</b></p><p>Prior experience in one or more:
</p><ul><li>Data Engineering (ETL/ELT, pipelines, orchestration)
</li><li>Data Science / ML lifecycle (especially NLP)
</li>Analytics engineering / data products<br>
<li>
</li></ul><div></div><p><b>Good-to-Have / Preferred
</b></p><ul><li>Exposure to <b>model fine-tuning (LoRA/PEFT) or prompt optimisation techniques
</b></li><li>Experience with <b>evaluation of LLM outputs (quality, relevance, latency)
</b></li><li>Understanding of <b>enterprise data privacy and security considerations in GenAI
</b></li><li>Exposure to <b>Azure AI / Azure OpenAI / AI Search ecosystems
</b></li><li>Experience working on <b>real client-facing AI solutions or POCs</b></li></ul></div><div></div>

AI Data Engineer

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