Trainer – Quality Analyst, Data Mining, Payment Integrity

EXL

. Facilitate training sessions, refresher education, coaching discussions, and one-on-one support .

Posted 10/12/2026full-timeRemote • United StatesMid-LevelSenior💰 $75,000 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates extensive knowledge of medical claims processing, healthcare reimbursement, and audit documentation requirements, with strong capabilities in training development and virtual facilitation. Proficient in analyzing audit results and implementing quality improvement initiatives while ensuring compliance with healthcare standards.

Highest-signal resume keywords

Medical Claims ProcessingHealthcare AuditingTraining DevelopmentQuality Assurance PrinciplesData Analysis Tools

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Complex Medical Claim ProcessingProvider Payment MethodologiesAudit Documentation RequirementsCPT CodingHCPCS CodingICD-10-CM CodingQuality ReviewError PreventionData Mining LogicHealthcare Compliance Standards

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationAnalytical SkillsCritical ThinkingCoaching Skills

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointMicrosoft OutlookMicrosoft WordFACETSNASCOEncoder ProTrueCode3MWebstrat/Webtrat

Certifications & Qualifications

CPC CertificationNationally Recognized Coding Certification

Industry Keywords

Payment IntegrityHealthcare ReimbursementOverpayment RecoveryClaim Quality ReviewAudit Validation

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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