Remote Claims Audit Specialist

Job Summary

A company is looking for a Remote Claims Audit Representative to support a healthcare facility.

Key Responsibilities

• Audit pre-lag reports for accuracy, completeness, and compliance
• Review and resolve member out-of-pocket discrepancies
• Conduct claims audits and quality reviews to ensure adherence to policies and regulations

Required Qualifications

• High School Diploma or equivalent
• 3+ years of experience in medical claims processing
• Experience using EZCap or similar claims adjudication systems
• Knowledge of Medi-Cal and HMO claims payment regulations