Medical Claims Auditor

Job Summary

Providing quality assurance auditing of post-payment claims, the full-time Medical Claims Auditor will work from home to ensure accurate adjudication and benefit application while compiling complex reports and offering feedback on accuracy.

Key responsibilities

• Audit claims daily using statistically valid sampling methods and perform necessary adjustments
• Compile and publish reports on claim audit results and processor productivity on a regular basis
• Identify trends from audit results and recommend improvements to enhance overall quality

Required qualifications

• High school diploma or equivalent
• 6 months to 2 years of experience in claim processing or customer service
• Proficiency in Facets claims processing applications and Benefit Tracker
• 10-key proficiency on a computer numeric keypad and a typing speed of at least 25 wpm
• Knowledge of Delta Dental's administrative policies affecting claims and customer service is preferred