Claims Auditing Specialist

Unified Group Services Inc • Anderson, IN

8d • Onsite

About The Position

Unified Group Services is a full-service third party administrator (TPA) for self-insured group health plans. We're dedicated to providing excellent customer service and the flexibility our customers desire in administering employee benefit plans. The Auditing Specialist is responsible for auditing claims for payment accuracy such as date of service, provider of service, diagnostic & procedure codes, modifiers, account number, coverage codes, and plan benefit type that are over a Claims Account Manager's check max to include spot checks. It also involves releasing and or resetting claims before the billing day. Auditors may also be called on to audit claim charges over $10,000 since they require a review by two auditors. This job requires basic knowledge of our PPOs, fee schedule maintenance, group maintenance, provider maintenance, and provider lists.

Requirements

• High School Diploma or GED.
• Working knowledge of Microsoft Word, Excel, and Outlook.
• Strong math skills.
• Attention to detail and the ability to meet deadlines.
• Professional phone communication skills.
• Good organizational skills and excellent customer service.
• Good writing skills, using proper grammar, punctuation, and sentence structure.
• Self-motivated & self-starter with a willingness to learn.
• Excellent attendance.

Nice To Haves

• Some college helpful but not required.

Responsibilities

• Auditing claims for payment accuracy (date of service, provider of service, diagnostic & procedure codes, modifiers, account number, coverage codes, and plan benefit type) that are over a Claims Account Manager's check max.
• Performing spot checks on claims.
• Releasing and/or resetting claims before the billing day.
• Auditing claim charges over $10,000 that require a review by two auditors.
• Maintaining basic knowledge of PPOs, fee schedule maintenance, group maintenance, provider maintenance, and provider lists.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED