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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.