Claims Auditor II

Job not on LinkedIn

🔥 2 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $63k - $84.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Perform audit samples on benefit coding, reimbursement, pricing, PIBA and pharmacy to ensure accurate claim adjudication and reimbursement. • Independently review assigned audit samples across PG, LOS, LDLA, and FEP audit programs, including claims, EDI, portal, inquiries, membership, and other operational work types. • Complete assigned audit volumes while maintaining accuracy, quality, and documentation standards. • Identify processing errors, variances, or noncompliant outcomes; cite audit points; and document rationale and supporting evidence. • Manage audit points through follow-up, validation, documentation updates, and closure. • Partner with business areas and internal team members to clarify information, confirm root causes, and resolve findings. • Use NASCO, Blue Squared, Local, BlueCard, supporting operational systems, and the department’s audit tool. • Maintain organized audit documentation for findings, re-review, reporting, and audit readiness. • Participate in calibration activities, share knowledge, and assist with onboarding or guidance for less experienced auditors. • Escalate unclear, conflicting, or complex scenarios to senior auditors or management. • Perform other job-related duties, special assignments, and operational support activities as assigned.

🎯 Requirements

• High School Diploma/GED required. • 3-5 years of claims processing experience required. • Knowledge of systems such as NASCO. • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement

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