Manager, Payment Integrity

Work location: Hybrid in Hartford, Connecticut
Salary range: $70,000 - $90,000 annually + bonus
Travel 10%
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

The Manager of Payment Integrity is responsible for preparing and executing Medicaid CXT/Cotiviti editing test scripts, ensuring comprehensive validation of coding and clinical edits. The Manager will document discrepancies, analyze claim‑processing functionality, and conduct thorough pre‑ and post‑implementation testing to ensure edit quality and accuracy. This role requires strong analytical ability to understand edit logic, process all claim types, and deliver clear release results and issue documentation. 

• EXL resources to prepare and execute the Medicaid CXT/Cotiviti Editing Test scripts
• Prepare Detailed documentation of all discrepancies, full understanding of testing functionality and claims processing.
• Prepare and edit test scripts for Medicaid coding and clinical editing.
• Perform comprehensive pre- and post-implementation testing of new edits for both vendors.
• Prepare & execute test scripts to ensure quality of edits.
• Resources to Understand and document issues
• Prepare pre- and post-implementation release results.
•  Ability to understand edits and understand processing of all type of claims.

Required

• Bachelor’s/Master’s degree in Computer Science / IT / Engineering or equivalent experience
• 6 plus years of experience in payment integrity claims processing
• High integrity, sound judgment, and independence of thought