Healthcare Claims Audit Specialist

Job Summary

A company is looking for a Specialist, Configuration Oversight focused on healthcare medical claim audits.

Key Responsibilities

• Conducts healthcare claim audits, ensuring accuracy and adherence to business and system requirements
• Reviews and evaluates updates to member enrollment, provider contracts, and claim processing guidelines
• Documents audit results and presents findings to management for recommendations and improvements

Required Qualifications

• Associate's Degree or equivalent combination of education and experience
• Minimum 2 years of experience as an operational auditor in core operations
• Previous experience in claims processing or examination
• Knowledge of claims processing systems, specifically QNXT
• Experience with Microsoft applications including Excel, Word, and Outlook