Medical Management Examiner - Hybrid

Auxiant•Cedar Rapids, IA

2d•Hybrid

About The Position

Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing, progressive company offering an excellent wage and benefit package. This position serves as a liaison for the Auxiant Medical Management (AMM) program, providing critical coordination and communication for cost containment and medical management for customer plans. The individual must make sound decisions on partner recommendations in the best interest of the client and participants, consistent with the plan document. This role also supports the Medical Management Supervisor and requires efficiency, accuracy, and excellent multi-tasking skills in a fast-paced environment.

Requirements

High school diploma and 2-4 years related experience; or Associates or Bachelor’s degree with some related experience
General understanding of medical terminology & claims examiner experience
The ability to work independently.
The ability to load balance work.
Proficient PC skills including e-mail, record keeping, routine database activity, word processing, spreadsheet, 10-key
Proven experience in a professional office environment
Outstanding written and verbal communication skills
Excellent mathematics and analytical skills

Responsibilities

Review High Dollar Claims and vendor recommendations and apply decisions based on the Plan Document, stop loss insurance, ppo contracts, etc.
Make clear and concise decisions in the best interest of client and the plan participant
Run reports for claim suspends and reconciliation for Accounts Payables
Coordinate with Claims surveillance partners
Claims processing, research and customer service
Data-entry
Manage all aspects of daily processes and accurately identify and present issues to vendors that will optimize the AMM program.