Seeking Claims Auditor with experience in medical claims for stop loss insurance providers to:

*** Audit claims for the check run processes.

*** Review duplicate reports.

*** Send check run summary report and Duplicate report to Chief Administrative Office and complete the check run process.

*** Run daily, weekly, and monthly tracking reports in the system for EZ-Cap, Crystal reporting, and other required databases.

*** Provide documentation to Director of Claims of the error findings and preliminary scores on all audits; assist creation of corrective action plan.

*** Coordinate with the staff to make sure claims process is finalized.

*** Assist Claims Supervisors with training new Claims Examiners and other employees on daily claims workflow process.

*** Provide direction to staff regarding claims timeliness guidelines, Contracts, new rules from governing agencies, and overall claims background.

*** Verify claims are being processed according to the Health Plan Division of Financial Responsibility (DOFR) when reviewing for audit issues & error.

*** Coordinate communication regarding Claims, Provider Fee Schedules, contracting issues, and other operational related matters.

Grow with a company offering an industry competitive compensation package, full medical, dental, and vision benefits, 401(k) retirement plans, excellent professional development opportunities, flexible paid time off, and more!

For details contact Mason Ingling at:
(609) 584-9000 ext 239

Or submit resume online at:
http://dmc9.com/mpi/app.asp

Or email to:
1000034438_10007348@jobbank303.com

Please reference #38257193 when responding.

2+ years

California

$50,000.00

$80,000.00

Mason Ingling

(609) 584-9000 ext 239

1000034438_10007348@jobbank303.com

http://dmc9.com/mpi/app.asp

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