Claims Auditor

Job not on LinkedIn

7 hours ago

🗽 New York – Remote

Although this job is listed in New York, this company may be open to hiring remote in other states.

💵 $52k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Centivo

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Healthcare Insurance

Centivo is an innovative health plan provider for self-funded employers that focuses on delivering high-quality healthcare at an affordable cost. The company believes in the power of primary care to improve health outcomes and reduce costs. Centivo offers plans with free primary care, no deductibles, and low, predictable copays, thereby encouraging members to utilize their health benefits without financial burden. The plans are curated to meet stringent price and quality standards, promoting a strong relationship with primary care providers and integrating virtual care options. Centivo's approach is designed to reduce overall medical expenses while enhancing the healthcare experience for both employers and employees.

201 - 500 employees

Founded 2017

⚕️ Healthcare Insurance

📋 Description

• Perform auditing of claims, ensuring processing, payment, and financial accuracy by verifying all aspects of the claim have been handled correctly and according to both standard process and the client’s summary plan description. • Completes reporting of audits finalized with decision methodology for procedural and monetary errors, which are used for quality reporting and trending analysis utilizing QA tools. • Responsible to communicate corrections and adjustments to Examiners as identified on pre-payment audits, including high dollar claims, and to verify corrections and adjustments are complete and accurate. • Identify and escalate trends based on the quality reviews. • Confer with Claims QA Lead, Claims Supervisors, Claim Managers, and/or Training Lead on any problematic issues warranting immediate corrective action. • May investigate and research issues as required to create or improve standard processing guidelines and may participate in projects as a subject matter expert as needed. • Perform any other additional tasks as necessary, including processing of claims, creating policies, training, and/or mentoring examiners through quality improvement plans.

🎯 Requirements

• Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred. • Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines. • Strong analytical, organizational, and interpersonal skills, with the ability to communicate effectively with others. • Attention to details, organized, quality and productivity driven. • 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 with self-funded health care plans and processing in a TPA environment, meeting production and quality goals/ standards. • Proficient experience in MS Word, Excel, Outlook, and PowerPoint required.

🏖️ Benefits

• Offers Equity • Offers Bonus