Claims Auditor

A company is looking for a Claims Auditor who will conduct audits across various employer groups and product lines to ensure claims processing integrity.

Key Responsibilities

Perform auditing of claims to ensure accuracy in processing, payment, and adherence to client specifications

Complete audit reporting and communicate necessary corrections to Examiners based on pre-payment audits

Identify trends from quality reviews and collaborate with team members on corrective actions

Required Qualifications

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 in a TPA environment

Prior experience with automated claims processing systems, preferably El Dorado-Javelina or Health Rules Payer (HRP)

Proficient in MS Word, Excel, Outlook, and PowerPoint

Detailed knowledge of processing principles and guidelines