Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit.
Primary duties may include, but are not limited to:
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Preferred Requirements:
Job Level: Non-Management Exempt
Workshift: 1st Shift (United States of America)
Job Family: CLM > Claims Support
Claims Auditor Lead • Grand Prairie, TX, United States
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