Claims Auditor

Job Summary

Responsible for conducting quality audits of claims processes, the full-time Claims Auditor will work remotely to identify trends and exceptions, provide feedback to management, and recommend improvements to enhance service quality.

Key responsibilities

• Perform routine and moderately complex audits to identify trends and report quality standards impacting the business unit
• Proactively identify performance trends and recommend improvements to workflow processes and policies
• Research claim processing issues, provide feedback to relevant stakeholders, and ensure timely completion of contested claims

Required qualifications

• High School Diploma required
• Minimum one year of relevant experience in Health Care Claims
• In-depth knowledge of Contracts, Benefit Application, and Coordination of Benefits