Claims Auditor
About The Position
Audits Claims, Customer Service and OA personnel by performing the following duties. Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines. Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service. Documents, maintains and reports audit statistics. Accurately interprets claim policy, procedures and standard group benefit provisions. Provides feedback to management and reviewed employees regarding quality of work. Maintains confidentiality of employee audits. Adheres to company rules and regulations. Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner. Performs other duties as assigned.
Requirements
- One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience
- Medical, dental and hospital claims processing experience
- Strong understanding of computerized claims payment systems, preferably at Delta Health Systems
- Excellent organizational skills
- Thorough understanding of technical claims issues and system edits
- Working knowledge of Microsoft Word and Excel
- Exceptional analytical skills
Responsibilities
- Audits Claims, Customer Service and OA personnel
- Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines
- Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service
- Documents, maintains and reports audit statistics
- Accurately interprets claim policy, procedures and standard group benefit provisions
- Provides feedback to management and reviewed employees regarding quality of work
- Maintains confidentiality of employee audits
- Adheres to company rules and regulations
- Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner
- Performs other duties as assigned
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
