Claims Auditor

Job Description

Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary:

The Claims Auditor position reports to the Chief Administrative Officer. This position audits claims processed by our claims department daily and is responsible to ensure accuracy and compliance.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Audits claims for coding accuracy, benefit payment, contract interpretations, and compliance with policies and procedures.
• Selects claims through random processes and/or other criteria.
• Makes recommendations to improve quality, workflow processes, policies and procedures.
• Prepare monthly reports of processor accuracy.
• Perform other duties as assigned.

GENERAL EXPECTATIONS:

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer, co-worker, producer or supervisor.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, and employees.

SERVICE EXPECTATIONS:

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Provide assistance whether the request falls within your specific job duties.
• Respond to internal and external requests in a timely manner, returning calls and emails promptly.
• Makes decisions based on departmental needs.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our company.
• Remain aware of products and services provided by Consociate Health.
• Project a positive, professional image when working.

Benefits:

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.

KNOWLEDGE, SKILLS AND ABILITY REQUIREMENTS:

• High School Education Required.
• Experience in Healthcare Claims Processing preferred.
• Auditing experience a plus.

PHYSICAL AND MENTAL ABILITIES:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
• The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.