Claims Auditor

Key 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.

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