Medical Claim reputed company Auditor (Remote)

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 reputed company
• 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
• 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

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