Process Auditor I

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. To ensure excellent customer service by responding in a timely, accurate and thorough manner to written and telephone inquiries from hospitals/ancillaries.

Requirements

High School Diploma/GED required.
1 to 2 years customer service/benefit processing experience.
Strong PC skills
Analytical thinking
Strong written and verbal communication necessary
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Nice To Haves

Strong knowledge of Medical terminology preferred.

Responsibilities

Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim.
Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures.
Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS).
Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy.
Anticipate and resolve potential issues and follow through on commitments made to the customers.
Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals.
Follow up on unresolved issues via outbound calls, emails or faxes.
Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality.
Submit provider file updates as appropriate.
Receive inbound telephone calls as they relate to recovery efforts
Perform other related tasks as assigned by management.