Auditor (Claims)
About The Position
The Claims Auditor is responsible for auditing medical and/or dental claims and supporting the team manager in creating, maintaining, and providing statistical audit reports and documentation. The role requires applying knowledge of plan designs and maintaining working knowledge of policies, procedures, compliance regulations, schedules of benefits, and turnaround times across product lines. The auditor researches claim-processing issues, prepares management reports with observations and recommendations, and helps test system functionality during upgrades and implementations. The position also involves collaborating with team members, participating in meetings and training, and completing additional assigned projects.
Requirements
- High school diploma or GED.
- Three years of recent experience analyzing medical claims.
- Ability to maintain production and quality standards.
- Extensive knowledge of medical terminology, CPT codes, ICD-9/10, and medical claim forms.
- Ability to read, analyze, and assess medical documentation and draw valid conclusions.
- Typing proficiency of at least 40 WPM and 3,000 KPH.
- Solid knowledge of MS Excel and MS Word.
- Professional, client-focused approach to colleagues and assignments.
- Strong oral and written communication skills and exceptional attention to detail.
- Ability to seek out experiences that may change perspective or provide opportunities to learn.
- Strong dedication to following through on tasks and assignments.
- Ability to organize, set priorities, work independently, and complete multiple projects within established deadlines.
Responsibilities
- Gain and maintain understanding of plan designs and apply that knowledge effectively.
- Maintain a comprehensive working knowledge of policies, procedures, compliance regulations, schedules of benefits, and turnaround times across all product lines.
- Research claim-processing issues to determine their origin and appropriate resolution.
- Prepare management reports summarizing observations and recommendations.
- Assist in testing system functionality during upgrades and implementations.
- Work cooperatively with other team members.
- Participate actively in team meetings and training activities.
- Perform additional responsibilities and projects as periodically assigned.
Benefits
- Medical, dental, and vision coverage.
- Short-term disability coverage.
- Company-paid supplemental dental coverage of $1,000 per year for the employee.
- Company-paid long-term disability and Life/AD&D coverage.
- 401(k) plan with company match up to 5%.
- Company-funded additional pension plan.
- Paid Personal Leave and vacation with annual buy-back options.
- Annual automatic pay increases.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
