Claims Auditor
About The Position
The Claims Auditor audits the work of the self-funded Claims and Customer Service departments for accuracy according to established procedure guidelines. The role reviews and identifies technical and system quality issues across claim processing, correspondence and reconciliation, and customer service. It documents, maintains, and reports audit statistics; accurately interprets claim policy, procedures, and standard group benefit provisions; and provides feedback to management and reviewed employees regarding quality of work. The Claims Auditor maintains confidentiality of employee audits, follows company rules and regulations, and maintains professional, efficient, and productive relationships with peers, subordinates, and superiors. Other duties may be assigned.
Requirements
- One-year certificate from a college or technical school, or one to three years of related experience, or an equivalent combination of education and experience.
- Medical, dental, and hospital claims processing experience.
- Strong understanding of computerized claims payment systems.
- Excellent organizational skills.
- Thorough understanding of technical claims issues and system edits.
- Working knowledge of Microsoft Word and Excel.
- Exceptional analytical skills.
Nice To Haves
- Experience with Delta Health Systems computerized claims payment systems is preferred.
Responsibilities
- Audit work of the self-funded Claims and Customer Service departments for accuracy according to established procedure guidelines.
- Review and identify technical and system quality issues in claim processing, correspondence and reconciliation, and customer service.
- Document, maintain, and report audit statistics.
- Interpret claim policy, procedures, and standard group benefit provisions accurately.
- Provide feedback to management and reviewed employees regarding quality of work.
- Maintain confidentiality of employee audits.
- Adhere to company rules and regulations.
- Maintain professional and productive relationships with peers, subordinates, and superiors.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
