About this role
Audits Claims, Customer Service and OA personnel by performing the following duties.
- Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines.
- Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service.
- Documents, maintains and reports audit statistics
- Accurately interprets claim policy, procedures and standard group benefit provisions
- Provides feedback to management and reviewed employees regarding quality of work
- Maintains confidentiality of employee audits
- Adheres to company rules and regulations.
- Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner
- Performs other duties as assigned
Qualifications
EDUCATION/EXPERIENCE: One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience.
QUALIFICATIONS: Successful candidate will have medical, dental and hospital claims processing experience; a strong understanding of computerized claims payment systems, preferably at Delta Health Systems; excellent organizational skills; a thorough understanding of technical claims issues and system edits; working knowledge of Microsoft Word and Excel; and exceptional analytical skills.