A company is looking for a Claims Auditor to perform in-depth audits of health benefit plans.
Key Responsibilities
Conduct routine and complex audits on claims for payment integrity
Research claim processing problems and prepare reports with recommendations
Adjudicate specific stop loss claims and process adjustments according to policy terms
Required Qualifications
BS/BA degree preferred
1 to 3 years of experience as a medical/dental claims auditor
3 years of experience processing group health claims preferred
Knowledge of CPT and ICD-10 & ICD-9 coding
Exceptional understanding of summary plan descriptions of employee benefits
