Claims Auditor I

About The Role
Perform routine and complex audits including but not limited to enrollment and maintenance, claims adjudication and adjustments, member and provider data integrity in the claim.  Develop, prepare and report results of audits, and provide error statements for explanation of errors to audited staff and managements.  Assist in identifying the root cause of errors in line to system configuration vs manual processing.  
*This is a remote role.

Primary Responsibilities

• Perform routine and complex audits including but not limited to enrollments & maintenance, claims adjudication & adjustments, member & provider data integrity in the claim.

• Develop, prepare and report results of audits; and provide error statements for explanation of errors to audited staff and management.

• Assist in identifying the root cause of errors in line to system configuration vs manual processing.
• Partner with Trainers to identify areas/topics for new/re-fresher training and assist with the documentation.

​​​​​​Essential Qualifications

• High School or Diploma

• Minimum 5 years in auditing of claims adjudication
  Working knowledge of medical terminologies and coding considered to be added advantage.

• MS Office Suite applications, including but not limited to: Word, Excel, Outlook, PowerPoint 

• Strong analytical aptitudes, communication, and comprehension capabilities
  
  At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.
  
  For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
  Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.