Claims Examiner/Auditor
Are you a seasoned healthcare claims professional with experience in claims auditing and examination seeking a fulfilling position with a respected healthcare company? Are you looking for the opportunity to advance and grow with a prestigious healthcare organization? If this describes you, this position can be the start of a great career.
Job Responsibilities
- Examine, review, and process claims
- Interpret claim forms
- Analyze claims costs
- Coordinate benefits
- Resolve claims through approval or denial
- Conduct routine and complex claims audits
- Document findings, approvals, and recommendations
- Analyze trends, successes, and issues in claims process
- Recommend desirable workflow and business rules refinements to improve the company claims process when applicable
- Perform reports on claims analysis
- Run audit reports and random checks
- Support the company’s audit needs
- Provide feedback of findings to the Claims and Auditing departments for quality improvement
- Claims research for new CMS, Medicaid, and Commercial rules and guidelines
- Maintain and support quality customer service
Minimum Requirements
- High school graduate, some college preferred
- One year prior experience as a claims examiner/auditor in a healthcare environment
- Extensive knowledge of claims and auditing process
- Knowledge of and adherence to accepted standards of health policy provisions and guidelines
- Possess strong verbal, written, and interpersonal communications skills
- Attention to detail
- Knowledge of medical coding systems and terminology
- Computer Software proficiency, i.e. Microsoft Office, Excel, PowerPoint, and ACCESS
- Strong organizational skills
- Ability to multi-task and prioritize
- Strong adherence to confidentiality of claims information
Advantages of this Opportunity
- Competitive salary commiserate with experience
- Health benefits available
- Fun and encouraging work environment
- Opportunity to make an impact in the healthcare field
Apply today for a fulfilling and rewarding career experience.