Medical Claims Auditor

Minimum of 2 years of experience in customer service or claims processing, preferably within the healthcare or employee benefits industry.

Written and Oral Communication Skills: Proven ability to respond to internal customers in a professional, accurate and thorough manner.

Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Comprehensive medical, dental, vision, and life insurance coverage

Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)

Review and audit medical claims for accuracy and compliance with company policies and benefit plan parameters.

Listen to customer service phone calls for accuracy and professionalism.

Provide feedback, coaching, and mentoring to claims and customer service staff members on results, best practices and compliance issues.

Prepare summary and detailed reports on audit findings, trends, and recommendations for process enhancements.

Stay updated on industry changes in medical coding, billing regulations, and insurance policies.

Assist in developing and implementing audit policies and procedures.