Claims Auditor

Job Summary

A company is looking for a Claims Auditor to perform in-depth audits of health benefit plans.

Key Responsibilities

• Conduct routine and complex audits on claims for payment integrity
• Research claim processing problems and prepare reports with recommendations
• Adjudicate specific stop loss claims and process adjustments according to policy terms

Required Qualifications

• BS/BA degree preferred
• 1 to 3 years of experience as a medical/dental claims auditor
• 3 years of experience processing group health claims preferred
• Knowledge of CPT and ICD-10 & ICD-9 coding
• Exceptional understanding of summary plan descriptions of employee benefits