Claims Auditor
Core
Performs routine and moderately complex audits of claims adjudication processes to identify trends, issues, and exceptions, ensuring quality service goals and standards are met.
Role type
Claims Auditor
Builds
Audit reports and feedback on claim processing errors
Domain
Health Care Claims
Deliverable
dashboards & analysis
Required skills
Claims adjudication, Contracts, Benefit Application, Coordination of Benefits, Policy and procedure knowledge, Data entry, Trend analysis, Coaching
Responsibilities
Perform audits to identify trends and exceptions; Provide feedback on contested claims; Research claim processing errors; Enter audit data into database; Coach examiners on findings; Monitor and prioritize aged audits.
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