Executive, Clinical Auditor

EXL

Clinical Auditor reviewing medical claims, diagnoses, and procedures against medical records for a healthcare services company. Ensuring CMS compliance, audit accuracy, and billing improvement.

Posted 9/3/2026full-timeChennai • 🇮🇳 IndiaMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in auditing medical claims for accuracy and compliance with CMS guidelines, while effectively collaborating with multidisciplinary teams to resolve discrepancies and support quality assurance initiatives.

Highest-signal resume keywords

Bachelor’s Degree In NursingActive State Nursing CertificationClinical/Hospital ExperienceMedical Terminology FamiliarityUS Healthcare System Understanding

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Claims ReviewAudit Findings PreparationCompliance ValidationDocumentation AuditingCoding Accuracy Identification

Soft Skills

Strong Written CommunicationOral Communication SkillsTeam CollaborationProblem-Solving Ability

Certifications & Qualifications

Active State Nursing Certification

Industry Keywords

CMS GuidelinesPayer PoliciesRegulatory RequirementsClinical DocumentationCare Management Concepts

About the role

Key responsibilities & impact

Review and audit medical claims against patient medical records for accuracy and completeness
Identify discrepancies between clinical documentation and billed services, including potential billing errors
Validate diagnoses, procedures, and levels of care against industry standards
Ensure compliance with CMS guidelines, payer policies, and regulatory requirements
Conduct best-practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities
Prepare structured audit findings and reports with corrective-action recommendations
Collaborate with coding, billing, and provider teams to resolve findings and support accurate claims
Monitor audit trends and identify recurring issues for education or intervention
Support quality assurance initiatives and maintain audit accuracy and productivity standards
Participate in continuous improvement and stay current on CMS regulations, clinical guidelines, and payer policy changes
Maintain productivity, clarification, and other required logs
Align with the Manager/Team Lead on program delivery and respond promptly to emails
Follow SOPs, project protocols, and process changes
Complete audits with expected quality and production targets

Requirements

What you’ll need

Bachelor’s degree in nursing
Active State Nursing certification is Mandatory
Minimum 3 years of clinical/hospital experience is mandatory
Strong written (documentation) and oral communication skills
Familiarity with basic medical terminology and care management concepts
Understanding of the US healthcare system and management
Ability to participate effectively in a multidisciplinary team
Must understand and adhere to the telecommuter policy
Shift time: 08:00 AM to 05:00 PM IST, subject to project requirements

Benefits

Comp & perks

Full-time schedule of 40 hours per week
Weekends off
High-speed broadband internet connection at home
Telecommuter policy support