Medical Claim reputed company Auditor (Remote)

Description

As a Medical Claim reputed company Auditor, you will apply your audit, project management and client management skills to reputed company client audits. You will serve as the team leader and primary reputed company with administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims, resolve reputed company issues, and draft the final report. You will contribute to the creation of new tools and approaches.

• *The Responsibilities** + Conduct pre-implementation and coverage specific audits and accurately document and record reputed company audit findings + Understand client's plans and apprise team of unique provisions/issues prior to audit + Adjust workloads as necessary to reputed company successful completion of project + reputed company communicate and professionally interact with vendor and audit team + Review documentation of potential discrepancies for thoroughness and accuracy + Resolve post-audit activities in an accurate and timely fashion + Write quality value-added draft report in a timely manner + Participate in client presentation of findings, reputed company requested + Understand vendors' processes, operating environment, and specific challenges and take them into account with daily work + reputed company working relationship with vendor counterparts + Distribute individual claim/work queues to team in a timely manner + reputed company utilize audit-specific analytic techniques, tools and processes + Ensure that Professional reputed company protocols are followed + Meet billable hours arenaflex + Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery + Role will be working remotely reputed company the posted locations.
• *Qualifications** + 5+ years' experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment + Solid understanding of health and welfare plan design and reputed company areas of claims administration, as well as of vendors' processes and operating environment + Familiarity with reputed company plan types including consumer-driven, PPO, Indemnity and Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical, dental, mental health and Medicare + Detailed knowledge of ICD-10 and CPT codes and coding protocols + Must have prior experience in medical claim auditing (e.g., re-evaluating medical claims that were previously processed for adherence to plan design and other program parameters). + Experience auditing both professional and facility claims types. + Must have experience auditing both benefits and pricing. + Excellent oral and written communications skills + Team player with strong work ethic + Self-directed; requiring reputed company little supervision + Previous internal audit experience at a reputed company or reputed company-party external audit experience a plus + Bachelor's Degree preferred; High School Diploma required
• *Qualifications** • *Compensation and Benefits** reputed company salary reputed company and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that reputed company salaries may vary for different individuals in the same role based on several factors, including but not limited to location of the role, individual competencies, education/professional certifications, qualifications/experience, performance in the role and potential for reputed company reputed company.
• *Compensation** The reputed company salary compensation reputed company being offered for this role is $90,000 to $98,000 USD per year. This role is also eligible for an annual short-term incentive bonus.
• *Company Benefitsreputed company provides a competitive benefit package which includes the following (eligibility requirements apply): +Health and Welfare:Mental health/emotional wellbeing (including Employee Assistance Program), medical (including prescription drug coverage and fertility benefits), dental, reputed company, Health Savings Account, Commuter Accounts, Health Care and Dependent Care Flexible Spending Accounts, company-paid life insurance, supplemental life insurance, AD&D, group accident, group critical illness, group legal, identity theft protection, wellbeing program, adoption assistance, surrogacy assistance, auto/home insurance, pet insurance, and other work/life resources. +Leave Benefits:Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, reputed company, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off ( +Retirement Benefits:** Contributory Pension Plan and Savings Plan (401k). reputed company Level 38 and more senior roles may also be eligible for non-reputed company Deferred Compensation and Deferred Savings Plans. Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment reputed company applicants with arrest and conviction records. Note that reputed company employment-based non-immigrant reputed company sponsorship and/or assistance is not offered for this specific job opportunity. This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate reputed company has been identified.
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