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Claims Department Auditor Jobs

Claims Qa Auditor - Claims - Paramount
By ProMedica At , Toledo, 43606, Oh
Experience or strong working knowledge of benefit/pricing configuration, provider database maintenance, or related configuration experience desired.
Associates degree in Finance/auditing strongly preferred
Spreadsheet and database skills required. Demonstrated Excel at least level 2
Excellent written, verbal, and interpersonal communication skills required
Quality assurance program experience highly desirable
Good working knowledge of HCFA, State of Ohio and Michigan compliance regulations, and institutional/professional ECS submission formats highly desirable.
Dental Claims Auditor- Remote (Ak, Az, Fl, Id, Or, & Wa)
By Moda Health At United States
Strong reading, writing, and verbal communication skills.
Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities.
Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines.
Proficiency in Facets claims processing applications and Benefit Tracker.
Knowledge of Power BI Report Server (PBIRS) is helpful.
Knowledge and understanding of Delta Dental’s administrative policies affecting claims and customer service.
Claims Auditor Jobs
By Morgan Stephens At Spokane, WA, United States

Our client is a great hospital system located in Spokane, WA

The compensation package includes a base pay of $60,000-$70,000 plus bonus potential!

Claims Auditor & Appeals Processor
By Planstin Administration At St George, UT, United States
Provide regular feedback to Claims Management concerning process improvement and/or training opportunities.
Provide regular feedback to Finance.
Knowledge and understanding of medical terminology, anatomy and both ICD-10 and CPT coding.
One or more years of experience working with insurance plans or self-funded options.
Two years' experience in medical claims processing.
Read and interpret Planstin plans to ensure payment accuracy.
Claims Auditor I Jobs
By State of Oklahoma At Oklahoma City, OK, United States
Demonstrate strong analytical interpersonal, problem solving, time management and negotiation skills.
If education, certification, or licensure is required to meet qualifications, applicants must provide documentation with application.
Complexity Of Knowledge, Skills, and Abilities
Principles and practices of business organization and management.
1-year of qualifying experience in business, accounting, finance, or public administration.
Initiate and maintain cooperative relationships with co-workers, managers and supervisors, claimants, and members of the public.
Claims Department Coordinator Jobs
By RAM Mutual Insurance At , Esko, 55733, Mn
Providing prompt, courteous, and high-quality work in response to management direction and internal customer needs.
Identifying and resolving problems according to departmental guidelines; offering first level problem resolution to customers and escalating inquiries appropriately.
Completing special projects assigned by manager.
Providing exceptional customer service to mutual partners, agents and policy holders as the primary point of contact for the department.
Responding to customer inquiries quickly, accurately and in a professional manner.
Assisting with claims set up, procuring documents/records, document retrieval, researching complex claim and policy coding issues, etc., as requested by Adjusters.
Claims Auditor- Remote Jobs
By Prime Therapeutics At , Remote $18.50 - $27.75 an hour
Completes special focused audits as assigned by management.
Knowledge of coordination of benefit guidelines.
Requires ability to read and understand benefit plans.
Experience with multiple claim processing systems.
Must function independently with strong organizational skills.
Strong verbal and written communication skills.
Medical Claims Auditor Jobs
By Imagine360 At United States
Elevate complex claim issues for clinician or management review
Facilitate financing of approved claims with finance
5+ years' experience in medical claims administration (carrier or provider); Understanding of medical Third Party Administration functions preferred
Knowledge of medical terminology required
Working knowledge of computers and software including but not limited to Microsoft Office products
Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
Claims Quality Auditor Jobs
By LA Healthcare Connections At , United, La

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll ...

Are you looking for an exciting opportunity to audit Claims Departments? We are looking for an experienced Claims Department Auditor to join our team and help us ensure that our Claims Department is operating efficiently and effectively. If you have the skills and experience to make a difference, we want to hear from you!

Overview The Claims Department Auditor is responsible for auditing the claims department of an organization to ensure accuracy and compliance with regulations. The auditor will review claims documents, investigate discrepancies, and provide recommendations for improvement. Detailed Job Description The Claims Department Auditor is responsible for auditing the claims department of an organization to ensure accuracy and compliance with regulations. The auditor will review claims documents, investigate discrepancies, and provide recommendations for improvement. The auditor will also review claims processing procedures and provide feedback to management. The auditor will be expected to identify areas of improvement and provide recommendations to management. Job Skills Required
• Knowledge of claims processing procedures and regulations
• Ability to analyze and interpret data
• Excellent communication and interpersonal skills
• Attention to detail and accuracy
• Ability to work independently and as part of a team
• Proficiency in Microsoft Office Suite
Job Qualifications
• Bachelor’s degree in accounting, finance, or related field
• Professional certification in auditing or related field preferred
• At least two years of experience in auditing or related field
• Knowledge of claims processing procedures and regulations
Job Knowledge
• Knowledge of claims processing procedures and regulations
• Knowledge of auditing principles and practices
• Knowledge of accounting principles and practices
• Knowledge of relevant laws and regulations
Job Experience
• At least two years of experience in auditing or related field
• Experience in claims processing or related field preferred
Job Responsibilities
• Review claims documents for accuracy and compliance with regulations
• Investigate discrepancies and provide recommendations for improvement
• Review claims processing procedures and provide feedback to management
• Identify areas of improvement and provide recommendations to management
• Prepare reports and present findings to management
• Monitor compliance with regulations and policies