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Job Title: Claims Auditor Remote
Position Type: 11+ Months
Location: 100% Remote
Job Description
• In-depth knowledge in claims life cycle
• Identify any system changes and work to notify the Plan CIA Manager on any risk or impact
• Configuring client System as per the requirement and according to defined business rules
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Audit check run and send claims to the claims department for corrections
• Identify issues, pends & trends and collaborate with appropriate teams for time resolution
• Document, submit, track, and resolve all claims projects
• Research the claims on various reports to determine if appropriate to move forward with recovery due to noncovered items being allowed, etc.
• Research verbal and written providers’ claims inquiries as needed
• Based on the business requirements and business rules gathered, evaluate, and create rules and complete the check run configuration activities
• Support Claims Project activities to update configuration within the core claims processing system, typically within the areas of Provider Pricing. Potential responsibilities include and may vary by system area of assignment
• Understanding of contract review and determine set up gaps
• Advanced knowledge of Microsoft applications; excel, Outlook, Team etc.
• SQL formatting and development for reporting
Regards,
Rahul Yadav
(408) 560-3956
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)
DISCLAIMER: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer or if you want to be REMOVED please reply with REMOVE in the Subject line of this email
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law (www.reqroute.com). We are committed to providing exceptional experience. To give feedback please email us at support@reqroute.com.
Claims Auditor Remote
WFM, RemoteJob Title: Claims Auditor Remote
Position Type: 11+ Months
Location: 100% Remote
Job Description
• In-depth knowledge in claims life cycle
• Identify any system changes and work to notify the Plan CIA Manager on any risk or impact
• Configuring client System as per the requirement and according to defined business rules
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Audit check run and send claims to the claims department for corrections
• Identify issues, pends & trends and collaborate with appropriate teams for time resolution
• Document, submit, track, and resolve all claims projects
• Research the claims on various reports to determine if appropriate to move forward with recovery due to noncovered items being allowed, etc.
• Research verbal and written providers’ claims inquiries as needed
• Based on the business requirements and business rules gathered, evaluate, and create rules and complete the check run configuration activities
• Support Claims Project activities to update configuration within the core claims processing system, typically within the areas of Provider Pricing. Potential responsibilities include and may vary by system area of assignment
• Understanding of contract review and determine set up gaps
• Advanced knowledge of Microsoft applications; excel, Outlook, Team etc.
• SQL formatting and development for reporting
Regards,
Rahul Yadav
(408) 560-3956
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)
DISCLAIMER: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer or if you want to be REMOVED please reply with REMOVE in the Subject line of this email
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law (www.reqroute.com). We are committed to providing exceptional experience. To give feedback please email us at support@reqroute.com.
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs.
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)