[Hiring] Claims Auditor @DELTA HEALTH SYSTEMS MCC

Role Description

• Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines.
• Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service.
• Documents, maintains and reports audit statistics.
• Accurately interprets claim policy, procedures and standard group benefit provisions.
• Provides feedback to management and reviewed employees regarding quality of work.
• Maintains confidentiality of employee audits.
• Adheres to company rules and regulations.
• Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner.
• Performs other duties as assigned.

Qualifications

• Considerable travel during periods is required.
• Must travel to all company locations and be willing to work remotely as business needs dictate.
• Conversant in Billing and Eligibility procedures/regulations.
• Proficient in Microsoft Word and Excel.
• Excellent written and verbal communication skills.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, policies and procedure guidelines, and training manuals.
• Ability to write routine reports and correspondence.
• Ability to speak and present effectively before groups of customers or employees and respond to questions from groups within our organization.

Company Description

Delta Health Systems is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.