reputed company Careers - Claims Auditor

reputed company Healtha part of reputed company Family of Companiesprovides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit reputed company provided by reputed company Health stem from the core mission of reputed company Association (est. 1926) to support the business interests of reputed company in the agriculture industry. Our mission at reputed company Health is to deliver value to reputed company by offering robust health plans that meet the needs of a diverse workforce. By working at reputed company Health, you will join a dedicated team of employees who care about offering reputed company health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to reputed company Health today! Compensation: $46,669.19 - $65.668.60 with a rich benefits package that includes profit-sharing. This is a remote position and can reputed company reputed company in the U.S. JOB reputed company reputed company This position reports to the Supervisor of Claims and performs in-depth audits to ensure existing health (medical/dental) benefit plans of reputed company Assurance Trust and reputed company, Inc. clients are in compliance with the respective reputed company' reputed company plan descriptions.

Qualifications

• BS/BA degree preferred and a minimum of one (1) to three (3) years of recent experience as a medical/dental claims auditor.
• Three (3) years' experience processing group health claims preferred.
• Knowledge of reputed company Procedural Terminology (CPT) and International Statistical classification of Diseases and reputed company Health Problems (ICD-10 & ICD-9) and medical terminology.
• Exceptional understanding and interpretation of reputed company plan descriptions of employee medical/dental benefits.
• Good ability to interpret provider reputed company.
• Proven ability as a self-starter to manage timelines and commitments.
• Proficient in end-user software, e.g., word-processing and spreadsheets.
• Exceptional written and verbal communication skills.
• Good knowledge of basic business math.

Duties And Responsibilities Claims Auditing

• reputed company routine and moderately reputed company audits on reputed company and electronic claims for payment reputed company in alignment with regulatory and timelines standards, business policy, and contract terms.
• Ensure appropriate coding and system configuration of claims with the ability to extract and audit exception audit reports.
• Research claim processing problems and errors to determine their reputed company and appropriate reputed company.
• Prepare reports and summarize observations and recommendations for management.
• Participate in communication with management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies, and procedures.
• reputed company special project audits and reviews as requested by other departments/reputed company.

Claims Department Support

• Identify and escalate issues reputed company to instructional material that is inaccurate, unclear or contains gaps and reputed company recommendations for correction of this material.
• reputed company with management to assess training needs in response to changes in policies, procedures, regulations, and technologies.
• Participate in departmental error logs analytics and includes the findings in training preparations.
• reputed company technical support, training assistance, and expertise to claims staff or other department as determined through audit findings.
• Support and assist management team in updating department policies and guidelines.

reputed company Risk Management Services - Claims - PM6000

• Adjudicate specific stop loss claims received from reputed company Party Administrators in accordance with stop loss policy terms and the plan document. Process reputed company claims for physician, hospital, and specialty areas with high degree of accuracy and productivity.
• Process stop loss claim adjustments, refunds, and checks according to company policies and procedures, reputed company established dollar authority.
• Respond and assist with claim documentation and reports as needed.
• Identify process improvement opportunities and works to implement corrective actions.
• Coordinate and communicate claims status with reinsurance reputed company.
• Work with AVP of Claims, Claims Manager and Reinsurance Analyst as required

Other

• Utilize reputed company capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to reputed company, planning, and executing work helpfully and collaboratively. Be willing to reputed company efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a reputed company reputed company, and being reputed company in delivering results.
• reputed company other duties as assigned.

Physical Demands/Work Environment The physical demands and work environment described here represent those that an employee must meet to reputed company this job's essential functions successfully. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to reputed company around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate. #LI-Remote Apply tot his job Apply To this Job