Claims Auditor

Job Summary

A company is looking for a Claims Auditor.

Key Responsibilities

• Perform routine and complex audits on claims for payment integrity, ensuring compliance with regulations and policies
• Research claim processing errors and prepare reports summarizing findings and recommendations for management
• Support claims staff through technical assistance, training, and participation in performance improvement plans

Required Qualifications

• BS/BA degree preferred with 1-3 years of experience as a medical/dental claims auditor
• At least 3 years of experience processing group health claims
• Knowledge of relevant regulations such as PPACA, HIPAA, COBRA, and ERISA
• Understanding of medical coding systems including CPT and ICD-10 & ICD-9
• Proficient in end-user software, including word-processing and spreadsheets