Claims Auditor I

MagnaCare • Las Vegas, NV

8d • Remote

About The Position

Perform routine and complex audits including but not limited to enrollment and maintenance, claims adjudication and adjustments, member and provider data integrity in the claim. Develop, prepare and report results of audits, and provide error statements for explanation of errors to audited staff and managements. Assist in identifying the root cause of errors in line to system configuration vs manual processing. This is a remote role.

Requirements

• High School or Diploma
• Minimum 5 years in auditing of claims adjudication
• MS Office Suite applications, including but not limited to: Word, Excel, Outlook, PowerPoint
• Strong analytical aptitudes, communication, and comprehension capabilities

Nice To Haves

• Working knowledge of medical terminologies and coding considered to be added advantage.

Responsibilities

• Perform routine and complex audits including but not limited to enrollments & maintenance, claims adjudication & adjustments, member & provider data integrity in the claim.
• Develop, prepare and report results of audits; and provide error statements for explanation of errors to audited staff and management.
• Assist in identifying the root cause of errors in line to system configuration vs manual processing.
• Partner with Trainers to identify areas/topics for new/re-fresher training and assist with the documentation.

What This Job Offers

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