[Hiring] Medical Director - Payment Integrity Services @EXL

Role Description

As Medical Director – Payment Integrity at EXL Health, you sit at the intersection of clinical practice, payor operations, and financial stewardship. You leverage your clinical expertise, managed care experience, and deep understanding of payer guidelines, regulatory requirements, and industry-standard policies to ensure claims are paid accurately, appropriately, and in full compliance with state, federal and plan-specific policies.

In this role, every decision influences how healthcare dollars are safeguarded and allocated, making you a key clinical authority within EXL’s Payment Integrity team.

• Collaborate closely with senior leaders, analytics partners, and Operations teams to connect clinical insight with business strategy.
• Help interpret the clinical impact of coding changes, regulatory updates, or new data patterns.
• Shape how our payment integrity programs respond, contributing to the evolution of new concepts and solutions.

Qualifications

• Clinical expertise in healthcare.
• Managed care experience.
• Deep understanding of payer guidelines and regulatory requirements.

Requirements

• Experience in payment integrity and claims management.
• Strong analytical and problem-solving skills.
• Ability to collaborate with cross-functional teams.

Benefits

• Competitive salary range: $215,000 - $290,000.
• Comprehensive health benefits.
• Opportunities for professional development.