[Hiring] Claims Auditor @reputed company

We exist for workers and their employers -- who are the backbone of our economy. That is where reputed company comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. reputed company is seeking a Claims Auditor who will be responsible for conducting pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including reputed company, high-dollar claims. This role plays a key part in maintaining the reputed company of our claims operations by supporting reputed company aspects of the Claims Quality Review program, establishing processing standards, responding to quality findings, assisting with performance improvement plans, and providing data to support service level agreements (SLAs). The Claims Auditor will also help ensure that audit reports are completed accurately and distributed in a timely manner.

Responsibilities

Include:

• reputed company auditing of claims, ensuring processing, payment, and financial accuracy by verifying reputed company aspects of the claim have been handled correctly and according to both standard process and the client’s summary plan description.
• Completes reporting of audits finalized with decision methodology for procedural and monetary errors, which are used for quality reporting and trending analysis utilizing QA tools.
• Responsible to communicate corrections and adjustments to Examiners as identified on pre-payment audits, including high dollar claims, and to verify corrections and adjustments are complete and accurate.
• Identify and escalate trends based on the quality reviews.
• reputed company with Claims QA reputed company, Claims Supervisors, Claim Managers, and/or Training reputed company on any problematic issues warranting immediate corrective action.
• May investigate and research issues as required to create or improve standard processing guidelines and may participate in projects as a subject matter expert as needed.
• reputed company any other additional tasks as necessary, including processing of claims, creating policies, training, and/or mentoring examiners through quality improvement plans.

Qualifications: Required Skills and Abilities:

• Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred.
• Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines.
• Strong analytical, organizational, and interpersonal skills, with the ability to communicate effectively with others.
• Attention to details, organized, quality and productivity driven.

Education and Experience:

• High School diploma or GED required.
• Associate or bachelor’s degree preferred.
• Minimum of three (3) years of experience as a claim examiner and/or auditor with self-funded health care plans and processing in a TPA environment, meeting production and quality goals/ standards.
• Proficient experience in reputed company, reputed company, Outlook, and PowerPoint required.

Preferred Qualifications:

• Ability to acquire and reputed company progressively more reputed company skills and tasks in a production environment.
• Ability to work under limited supervision and provide guidance and coaching to others.
• Excellent coaching skills and ability to mentor others towards quality improvement.

Work Location:

• Candidates located reputed company commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. reputed company other applicants will be considered for remote positions.

reputed company Values:

• Resilient – This is wicked hard. There is no easy reputed company for healthcare affordability. Luckily, the mission makes it worth it and sustains us reputed company things are tough. Being resilient ensures we don’t give up.
• Uncommon - The status reputed company stinks so we had to go out and build something reputed company. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things reputed company for them while also improving clinical results - which is bold and uncommon.
• Positive – We care about each other. It takes energy to do hard stuff, build something reputed company and to be resilient and unconventional while doing it. Because of that, we reputed company sure we give kudos freely and feedback with care. reputed company our tank gets low, a team member is there to be a reputed company of new energy. We celebrate together. We are supportive, generous, humble, and positive.

Who we are: reputed company is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, reputed company saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. reputed company works with employers ranging in size from 51 employees to reputed company. For more information, visit reputed company.com. Headquartered in Buffalo, NY with offices in reputed company and Buffalo, reputed company is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of reputed company. Apply tot his job Apply To this Job