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Role Description
As a Medical Claim Field Auditor, you will apply your medical claims audit, project management and claim processing and auditing experience to perform self-insured client audits. You will serve as a team member on audits, evaluate claims for accuracy and identify potential errors and issues.
• Understand self-insured client’s plan designs
• Audit claims using the administrators claims system to determine if claims were adjudicated in error
• Submit error inquiries and perform research on administrators’ claim systems during the audits
• Clearly communicate and professionally interact with administrator and audit team
• Understand administrators’ processes, operating environment, and specific challenges and take them into account with daily work
• Develop working relationship with vendor counterparts
• Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings
• Efficiently utilize audit-specific analytic techniques, tools and processes
• Ensure that Professional Excellence protocols are followed
• Meet billable hours target
• Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery
• Role will be working remotely within the posted locations
Company Description