Auditor (Claims)

The Claims Auditor is responsible for all audit activities for medical and/or dental claims while supporting the team manager to create, maintain and provide statistical audit reports and documentation.

Responsibilities

Auditing & Reporting

• Gain and maintain the understanding of the plan designs and effectively apply that knowledge.
• Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines
• Research claim processing issues to determine the origin and appropriate resolution
• Prepare reports for management summarizing observations and recommendations
• Assist in testing system functionality during upgrades and implementations

Teamwork

• Work cooperatively with other team members
• Actively participate in team meetings and training activities.
• Perform additional responsibilities and projects as periodically assigned.

Education/Certification:

• High School Diploma/GED
• Three (3) years recent experience analyzing medical claims

Skills/Abilities:

• Ability to maintain production and quality standards.
• Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.
• Ability to read, analyze and assess medical documentation and draw valid conclusions.
• Minimum 40 WPM and 3,000 KPH proficiency
• Solid knowledge of MS Excel & MS Word
• Professional, client-focused approach to colleagues and assignments.
• Strong oral and written communication skills with exceptional attention to details.
• Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
• Strong dedication to follow-through on all tasks and assignments.
• Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.
• Ability to sit for long periods of time operating a computer keyboard.

Employee Benefits Program

• COMPANY PROVIDES Healthcare benefits including MEDICAL, DENTAL ($1,500 per year, $1,000 per year for Plan B), VISION, SHORT-TERM DISABILITY benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for FULL FAMILY COVERAGE.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%.
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.