Title: Claims Auditor Location: Hyderabad, Telangana, India Remote Job Description: Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: - Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. - Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. - Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. - Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. - Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. - Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. - Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. - Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. - Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language. Required Qualifications - 3-5 years of experience overall - Expert-level coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines/Deep understanding of outpatient claims coding and auditing - Self-motivated and able to work independently in a remote environment while maintaining high performance. - Expertise in outpatient and professional coding audits to ensure accurate code assignment and compliant reimbursement. Leverage in‑depth knowledge of coding guidelines and industry‑standard tools to identify and maximize potential overpayment recoveries. - Exceptional time management, problem-solving, and analytical skills. - Passion for auditing and a commitment to teamwork, collaboration, and continuous learning. - Possess the CCS (Certified Coding Specialist) or CPC (Certified Professional Coder) credentials. - Superior knowledge of HCPCS, CPT, ICD-10-CM/PCS coding, and US healthcare payment methodologies for Commercial, Marketplace, Medicare, and Medicaid. - Right candidates will have experience with coding ambulatory surgery clinic claims and hospital observation claims to include injection and infusion claims. - Excellent candidates will also have experience auditing high-cost drug and/or Durable Medical Equipment claims. - Completion of a bachelor's degree. - Excellent written and verbal English communication skills, strong analytical skills, and attention to detail. Nice-to-haves - Experience using CMS NCDs/LCDs and clinical criteria guidelines. - ​​RHIA or RHIT credential. - Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability. - Familiarity with working with a diverse, global team of talent. - Excellent computer skills and familiarity with a Mac. Ability to commute/relocate: - Nacharam, Hyderabad, Telangana*: Reliably commute or planning to relocate before starting work (Preferred) About Cohere Health: Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction. With the acquisition of ZignaAI, we expanded our AI-native platform with a comprehensive Payment Integrity Suite that spans data mining, clinical and coding validation, authorization and claims reconciliation, and end-to-end payment integrity services across pre- and post-pay workflows. By connecting clinical and payment insights, our transparent, AI-powered solutions help health plans proactively improve payment accuracy, reduce waste and vendor dependency, strengthen provider relationships, and build smarter, more efficient payment integrity programs. Cohere Health’s innovations continue to receive industry-wide recognition. We’ve been recognized on TIME’s World Top HealthTech Companies 2025 list, the 2025 Inc. 5000 list, in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. We can’t wait to learn more about you and meet you at Cohere Health! Equal Opportunity Statement: Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal. ISMS roles and responsibilities - Fair understanding of Information Security practices. - Align to the organization policies and procedures. - Ensure to get updated with ISMS roles as assigned by the department/process heads

• Conducts internal and/or external timely operational, financial, and/or compliance audits • Identifies, documents, and evaluates business risks • Develops written audit programs • Conducts testing and analysis of existing controls • Prepares written work papers to document testing results • Documents issues, causes of those issues, and their effects • Serves as Lead Auditor on complex audit assignments • Drafts recommendations to limit risks and improve processes • Writes audit reports for corporate executive management • Collects and analyzes data to detect deficient controls • Conducts testing of corrective actions • Develops detailed reports on each audit conducted • Examine and evaluate financial and information systems • Conducts special audit studies for management • Provides training to other auditors

Role Description RTX Corporation is seeking an experienced QMS (Quality Management System) Auditor to join our Enterprise Quality Audit (EQA) team (2nd Party Audit). The QMS Auditor will be responsible for conducting second party QMS audits across RTX business units to ensure compliance with 91XX series, ISO9001, and other relevant standards. This role will involve identifying areas of strength, opportunities and non-compliance, and reviewing and approving corrective action plans. The ideal candidate will have a strong background in quality assurance within the aerospace, space, and/or defense industries, along with excellent analytical and communication skills. What You Will Do: - Travel Requirements: This position requires 70% travel, both domestically and internationally, and can be located within convenient access to a major airport. Depending on audit schedules and auditor home location, this may include some weekend travel. - Audit Responsibilities: - Plan, lead, and/or conduct second party QMS audits for compliance with the 91XX and ISO series of standards, RTX and business unit policies & procedures, and regulatory and customer requirements across RTX sites. - Perform formal responsibilities of a lead auditor such as audit planning in conjunction with the EQA audit planner, representing the audit team with site leadership, conducting opening and closing meetings, and daily debriefs with site personnel. - Ensure that processes, products, and services comply with internal standards, regulatory requirements, and industry best practices. - Complete and issue detailed audit reports, including findings, non-conformances, and review and approve effective corrective actions and ensure implementation effectiveness. - May assist RTX Certification bodies during site surveillance and recertification audits, including facilitating audit schedules, logistics, and closure of corrective actions. - May support special projects relating to audits as needed. - Data Analysis: - Support analysis of audit performance to identify trends, risks, and opportunities for continuous improvement. - Utilize data analytics to support comprehensive audit preparation and planning based on historical and current performance data. - Collaboration: - Work closely with regional leads of the EQA team and Ops Excellence lead to support the audit schedule, ensuring that sites across RTX are audited per the schedule. - Foster collaborative relationships with functional and business leaders to promote a transformative quality organization aligned with business objectives. - Participate in weekly Corrective Action Review Board meetings to review and approve/reject formal corrective actions. - Special Audits and Assessments: - Support special audits (e.g., suspensions, major customer complaints, high-risk sites, etc.), independent assessments, and site certifications as required by RTX business units. Qualifications - Typically requires a University Degree and minimum 8 years prior relevant experience or an Advanced Degree in a related field and minimum 5 years of experience or in absence of a degree, 12 years of relevant experience. - Minimum of 5 years of experience in quality assurance, with at least 3 years in QMS auditing within the aerospace, space, and defense industries. - Familiarity with 91XX series and ISO9001 standards. - Current authenticated AS9100 Lead Audit certification (evidence is required). - Ability to certify within one year as an Aerospace Auditor (AA) or Aerospace Experienced Auditor (AEA). - The ability to obtain and maintain a secret U.S. government issued security clearance is required. Requirements - Certification as an Aerospace Auditor (AA) or Aerospace Experienced Auditor (AEA). - Existing AATT (Aerospace Auditor Transition Training) Certification (evidence is required). - Experience planning and coordinating multiple audits simultaneously. - Working knowledge of ETQ/ BU Corrective Actions processes/systems. - Proficiency in presenting audit results and concepts to key stakeholders and executive management. - ASQ Certification (CQA, CQE, CMQ/OE). - Existing Secret Security Clearance (for Raytheon’s DoD contracts). - CORE certification. - Proficiency with audit management software and tools. - Ability to function effectively without direct supervision. - Excellent analytical, organizational, and communication skills. Benefits - Robust total rewards package with compensation; healthcare, wellness, retirement and work/life benefits; career development and recognition programs. - Parental (including paternal) leave. - Flexible work schedules. - Achievement awards. - Educational assistance. - Child/adult backup care.

Role Description The Utilization and Denials Management Auditor is responsible for the day-to-day production and quality functions of a team of Utilization and Denials Management specialists specializing in meeting client production goals and accuracy goals. The Auditor assists Utilization and Denials management in preparing daily operational reports, providing QA (quality assurance) feedback, and participating in client interactions and internal stakeholder meetings. Key Responsibilities: - Quality Assurance (QA) & Delivery: - Assists in QA program build, including advising on critical aspects of the workflow/accounts to audit. - Monitors performance of all Utilization and Denials Management staff using key metrics. - Escalates Production and QA concerns or roadblocks to the Manager as needed. - Demonstrates domain expertise in quality processes related to meeting production schedules. - Deep understanding of both production and quality assurance Utilization and Denials Management processes. - QA Administration & Documentation: - Experience providing training, coaching, and development to team members. - Monitors and maintains team QA records and auditing/education findings. - Completes special projects, such as full Utilization and Denials Management audits. - Mentors staff to maximize performance and potential. - Assists in maintaining and monitoring team members' job satisfaction and morale. - Performance & Evaluation: - Reviews production and quality accuracy reporting for all assigned projects. - Motivates team members through effective training and coaching. - Conducts monthly team meetings and annual performance evaluations. - Collaboration & Stakeholder Management: - Partners with global Operations, Training, and HR to streamline onboarding. - Participates in client calibration calls to align training KPIs with operational metrics. - Supports client visits, internal audits, and process reviews. - Other duties and responsibilities as assigned. Qualifications - Required Qualifications: - QA Experience: At least 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in a healthcare setting. - Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience. - Education: Associate Degree in Nursing (ADN) or Diploma in Nursing. - Licensure: Must be Registered Nurse with an active USRN license. - RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines. - Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech. - Preferred Qualifications: - Education: Science in Nursing (BSN) preferred. - Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred. - Software Knowledge: Proficiency with using computer programs for tracking authorization, and/or denials and appeals. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint). Benefits - The estimated base salary range for this job is $80,000 - $105,000. - The job is also eligible to participate in Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs.