Claims Audit Specialist

A company is looking for a Claims Audit Specialist (Remote).



Key Responsibilities

Conduct audits of processed claims to ensure compliance with regulations and identify errors
Prepare and maintain audit findings, providing feedback and recommendations for process improvement
Collaborate with internal and external partners to resolve claims processing deficiencies


Qualifications, Training, and Education

High School Diploma or GED with at least 5 years of claims auditing experience, or an Associate Degree with 2 years of relevant experience
Associate degree in Business Administration, Hospital Billing, or related field preferred
Proficiency in Microsoft Word, Excel, Outlook, and SharePoint
Knowledge of claims adjudication processes and healthcare data analysis
Ability to learn claims adjudication systems and multi-payer management information systems