Insurance Claims Quality Auditor

Job Description

Job Description

Who we are: 

ManhattanLife Insurance and Annuity Company was founded in 1850, the Company’s longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for over 175 years is a testimony to ManhattanLife’s enduring history, and an indicator of the reliability of our future. ManhattanLife’s headquarters are in Houston, TX and the company is continually growing with multiple office locations nation-wide. ManhattanLife offers attractive employee benefits starting day one, including immediate coverage under our health, dental and vision plans. We offer flexible schedules, including shortened hours on Fridays, free parking, company-wide events, professional development, and a company-wide wellness program.

Scope and Purpose:

The Claims Quality Auditor is responsible for providing Quality Assurance of processed claims. Operational processes must be reviewed for accuracy to ensure adherence and quality output for our customers and internal partners. This role is based at our Louisville, Kentucky office. 

Duties and Responsibilities:

• Audit internal paperwork and documentation as it transitions between Departments.
• Ensure Claims are processed in adherence to company policy and contract provisions.
• Ensure proper documentation accompanies all claims processed.
• Audit output of group/customer-facing documents.
• Manage all Audits, report discrepancies to case builder or leader; regression test corrections when provided.
• Assist Management in assessing and documenting process improvement areas based on quality review.
• Provide other Quality Assurance duties as needed by department.

Minimum Qualifications: 

High School Graduate or equivalent (GED); experience, education, and/or training in QA and claims processes; insurance knowledge and experience is a plus. 

 

Knowledge, Skills and Abilities:

 

• 1-3 years of claims experience preferred.
• Solid knowledge of ICD-9, ICD-10 or medical coding.
• Background in insurance claims is preferred in any discipline of Medicare Supplement, Life, Health, Cancer or Disability.
• Ability to read and understand policy language.
• Understanding of basic medical terminology.
• Ability to work independently and in a team environment.
• Ability to prioritize and manage workload to meet deadlines.

 

Travel Requirements:

This Louisville-based position does not require travel.

Professional Development:

• Establish annual objectives for professional growth.
• Keep pace with developments in the discipline.
• Learn and apply technologies that support professional and personal growth.
• Participate in the evaluation process.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and/or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice.

AAP/EEO Statement:

ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.