[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

• One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience.
• Successful candidate will have medical, dental and hospital claims processing experience.
• Strong understanding of computerized claims payment systems, preferably at Delta Health Systems.
• Excellent organizational skills.
• Thorough understanding of technical claims issues and system edits.
• Working knowledge of Microsoft Word and Excel.
• Exceptional analytical skills.

Company Description

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