Trainer / Quality Analyst - Data Mining, Payment Integrity

This position reviews completed audit findings, validates overpayment opportunities, confirms claim repricing accuracy and supporting documentation, develops and supports training plans and learning resources, and ensures 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, virtual training capability, effective communication skills, and the ability to provide clear feedback, coaching, and training support that strengthens auditor performance, continuous improvement, and 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

Responsibilities

• Facilitate training sessions, refresher education, coaching discussions, and one-on-one support to improve auditor performance, audit consistency, documentation quality, and compliance with applicable review standards.

• Provide training support for new and existing Data Mining auditors by explaining audit procedures, quality expectations, error trends, common claim scenarios, repricing concepts, and appropriate documentation practices.

• Create and maintain structured Data Mining learning resources, including job aids, tutorials, process documentation, knowledge checks, and refresher content to support onboarding, ongoing education, and consistent audit execution.

• Assess trainee and auditor understanding through audit results, quality trends, knowledge checks, and observed performance to identify learning gaps and recommend targeted coaching or refresher training.

• Perform quality control reviews of completed Data Mining audit findings to validate claim accuracy, payment methodology, recovery opportunity, and compliance with client-specific requirements.

• Review supporting documentation, including provider contracts, fee schedules, client claim systems, pricing references, coding guidelines, and audit notes to confirm findings are fully supported and clearly documented.

• Validate complex claim repricing completed through Data Mining audit processes using applicable client claims systems, pricing tools, CMS guidelines, coding resources, and program-specific procedures.

• Monitor, analyze, and report error trends, root causes, pass/fail outcomes, and recurring issues impacting payment accuracy, audit quality, and operational performance.

• Recommend corrective actions, training opportunities, and quality improvement initiatives to reduce payment errors, strengthen audit consistency, and improve overall performance.

• Evaluate current audit processes, controls, procedures, and Data Mining concepts; review query-driven audit outputs to ensure effectiveness, consistency, efficiency, compliance with quality expectations, and alignment with recovery outcomes.

• Partner with audit leadership, trainers, quality teams, and subject matter experts to clarify requirements, support calibration efforts, resolve training or quality gaps, recommend process improvements, and contribute to procedure updates and special projects.

• Ensure audit work aligns with client, program, regulatory, HIPAA, and company requirements while maintaining confidentiality and compliance standards.

Qualifications

• 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 with the ability to provide clear, professional, and actionable feedback.

• 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 for healthcare claims, auditing, quality review, or Payment Integrity teams.

• Ability to translate complex claims, audit, repricing, quality, and compliance concepts into clear virtual training content that supports different learning levels.

Knowledge and Skills

• 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; ICD-9 knowledge helpful where applicable.

• Ability to review query-driven audit outputs and understand how Data Mining logic supports claim selection, overpayment identification, audit validation, training needs, and quality outcomes.

• Strong analytical and critical-thinking skills with the ability to identify patterns, root causes, quality trends, process improvement opportunities, and corrective actions.

• Strong understanding of quality assurance principles, audit accuracy standards, error prevention, and structured review criteria.

• Effective written and verbal communication skills with the ability to provide clear, constructive feedback and collaborate professionally with auditors, leaders, trainers, and client-facing teams.

• Strong trainer presence with confident virtual facilitation, presentation, and instructional delivery skills for remote group training, refresher education, coaching discussions, and one-on-one learning support.

• Strong training development skills, including the ability to build organized virtual learning content that supports onboarding, audit accuracy, quality readiness, and employee performance.

• Ability to assess learner comprehension, identify training gaps, and adapt virtual training content to different experience levels based on audit results, knowledge checks, and observed performance.

• Ability to coach auditors through audit results, quality trends, documentation issues, and corrective actions to support improved performance and consistent audit outcomes.

• Proficiency with Microsoft Excel, PowerPoint, Outlook, Word, spreadsheets, databases, and data analysis tools.

• Demonstrated commitment to accuracy, quality, attention to detail, confidentiality, and compliance with client, company, and healthcare requirements.

Preferred Qualifications

• College degree preferred.

• CPC (Certified Professional Coder) 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 for healthcare claims, audit, quality, or Payment Integrity teams preferred.

This role is ideal for a detail-oriented training and quality professional who enjoys developing virtual learning resources, coaching auditors, validating audit accuracy, identifying trends, and helping teams improve outcomes.

What we offer:

• EXL offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth
• We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor
• The sky is the limit for our team members. The unique experiences gathered at EXL sets the stage for further growth and development in our company and beyond

The posted base salary range is the hiring base salary range for this role. 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.