Claims Auditor Specialist

Job Overview:

We are seeking a Claims Auditor Specialist to join our team. The ideal candidate will be responsible for reviewing and inspecting claims processes to ensure quality standards are met.

Key Responsibilities:

• Create accurate audit findings and recommendations to improve claim processing efficiency.
• Understand and apply coding and reimbursement guidelines, as well as provider and health plan contracts.
• Audit and assess medical records to identify errors and trends.
• Analyze inpatient and outpatient medical records using ICD-9/ICD-10, CPT, HCPCS, and other codes.
• Verify and validate claims documents to prevent documentation or coding errors.
• Prepare concise documentation and audit reports with recommendations for improvements.

Requirements:

• Bachelor's degree in a related field, such as Medical, Finance, Business Administration, or Insurance.
• 3-5 years' experience in a customer-focused environment, preferably in clinical or insurance roles.
• Proficiency in MS Office and general internet navigation skills.
• Demonstrated ability to work independently and detail-oriented.

What We Offer:

We provide a supportive work environment that fosters growth and development. Our employees enjoy a range of benefits, including hybrid working options and opportunities for professional development.

We believe in diversity and inclusion, and we welcome applications from candidates of all backgrounds.