Job Summary
An independent, not-for-profit health benefits organization is filling a position for a Remote Health Benefits Claims Audit Project Manager.
Core Responsibilities of this position include:
- Running queries for audit and FWA analysis based on clinical and coding criteria to identify outlier suspect claims
- Conducting routine and complex claims audits to identify overpayments and assists with the recovery
- Coordinating with other departments to identify opportunities for improvement
Qualifications for this position include:
- Bachelor's Degree or
- Equivalent work experience (4 years of professional work experience in a corporate environment)
- 1 year - Applicable system experience (Facets, etc.)
- 4 years - Auditing or other relevant experience
- 8 years - Claims processing, research and adjustment experience
- Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
