Trainer – Quality Analyst, Data Mining, Payment Integrity
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Job Description
Remote Trainer/Quality Analyst supporting EXL’s healthcare consulting business. Training Data Mining auditors, validating claim repricing, and improving payment integrity audit quality.
Responsibilities:
- Facilitate training sessions, refresher education, coaching discussions, and one-on-one support
- Provide training support for new and existing Data Mining auditors
- Create and maintain Data Mining learning resources, job aids, tutorials, process documentation, knowledge checks, and refresher content
- Assess trainee and auditor understanding through audit results, quality trends, knowledge checks, and observed performance
- Perform quality control reviews of completed Data Mining audit findings
- Validate claim accuracy, payment methodology, recovery opportunities, and compliance with client-specific requirements
- Review provider contracts, fee schedules, claim systems, pricing references, coding guidelines, and audit notes
- Validate complex claim repricing using client claims systems, pricing tools, CMS guidelines, coding resources, and program procedures
- Monitor, analyze, and report error trends, root causes, pass/fail outcomes, and recurring issues
- Recommend corrective actions, training opportunities, and quality improvement initiatives
- Evaluate audit processes, controls, procedures, and Data Mining concepts
- Review query-driven audit outputs for effectiveness, consistency, efficiency, compliance, and recovery alignment
- Partner with audit leadership, trainers, quality teams, and subject matter experts on requirements, calibration, quality gaps, process improvements, procedure updates, and special projects
- Ensure audit work aligns with client, program, regulatory, HIPAA, and company requirements while maintaining confidentiality
Requirements:
- High School Diploma required
- Minimum 5+ years of experience in medical claims, healthcare auditing, Payment Integrity, coding, claim quality review, or related healthcare operations
- Strong understanding of complex medical claim processing, provider payment methodologies, claim systems, and audit documentation requirements
- Ability to interpret client requirements, provider contracts, fee schedules, coding guidelines, pricing rules, and healthcare compliance standards
- Strong verbal and written communication skills
- Ability to work independently, manage multiple priorities, meet deadlines, and maintain accuracy in a production-based environment
- Ability to develop or deliver virtual training materials, coaching plans, process guidance, job aids, and knowledge checks
- Ability to translate complex claims, audit, repricing, quality, and compliance concepts into clear virtual training content
- Extensive knowledge of medical claims processing, healthcare reimbursement, provider payment logic, and overpayment recovery concepts
- Strong understanding of CMS pricing and reimbursement guidelines, provider contract interpretation, fee schedules, coding resources, and healthcare compliance standards
- Knowledge of CPT, HCPCS, ICD-10-CM, and medical coding methodologies
- Ability to review query-driven audit outputs and understand Data Mining logic
- Strong analytical and critical-thinking skills
- Strong understanding of quality assurance principles, audit accuracy standards, error prevention, and structured review criteria
- Confident virtual facilitation, presentation, and instructional delivery skills
- Strong training development skills
- Ability to assess learner comprehension, identify training gaps, and adapt virtual training content
- Ability to coach auditors through audit results, quality trends, documentation issues, and corrective actions
- Proficiency with Microsoft Excel, PowerPoint, Outlook, Word, spreadsheets, databases, and data analysis tools
- Commitment to accuracy, quality, attention to detail, confidentiality, and compliance
- College degree preferred
- CPC or other nationally recognized coding certification preferred
- Relevant experience may be considered in lieu of certification
- Experience with Payment Integrity, healthcare reimbursement, or overpayment recovery audits preferred
- Prior experience performing quality reviews, claim audits, or audit validation strongly preferred
- Experience applying quality criteria, audit scorecards, accuracy standards, or structured quality review guidelines preferred
- Experience with healthcare claim systems and industry tools such as FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat/Webtrat, and applicable pricers preferred
- Prior experience creating virtual training programs, job aids, assessments, and support tools preferred
Benefits:
- Exciting, fast-paced, and innovative work environment
- Opportunity to work closely with experienced healthcare consultants
- Exposure to multiple aspects of clients’ businesses
- Teamwork and time-management development
- Mentoring program with guidance and coaching from a senior-level advisor
- Growth and development opportunities
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