Offer summary
Qualifications:
High School Diploma or Equivalent, 2-3 years experience as medical claims Auditor.
Key responsabilities:
- Analyze and monitor trends through audit process
- Run reports on errors, assist in processing PDRs and Health Plan Cap Deducts, handle special projects
- Audit high dollar claims, make necessary adjustments for underpayments and review overpayment requests
- Prepare Health plan claims selections for Annual health plan audit, review sample provider by clerical staff
- Correspond with external providers regarding Claims Overpayment requests, analyze Claims processing methodologies according to guidelines