Medical Claims Auditor

Job Summary

A company is looking for a Medical Claims Auditor.

Key Responsibilities:

• Review and audit medical claims for accuracy and compliance with company policies
• Listen to customer service phone calls for accuracy and professionalism
• Provide feedback and coaching to claims and customer service staff members

Qualifications:

• Minimum of 2 years of experience in customer service or claims processing, preferably in healthcare
• Strong knowledge of benefits plan design and auditing processes
• Experience with medical terminology, ICD-10, and CPT coding
• Ability to analyze issues and work with management to implement solutions
• Experience with self-funded plans and TPAs is highly desirable