Claims Quality Auditor jobs in Nashville, TN

The primary role of the Claims Analyst is to review, identify, and validate claim overpayments. Types of overpayment reviews will include, but are not limited to, Duplicate Payment, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits, Medical Review, and Medicare and Medicaid reimbursement policies. 

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Responsibilities may include, but are not limited to the following:  

• Work with team members to ensure project goals are met efficiently and effectively. 
• Achievement of individual productivity and quality goals. 
• Communicate to management any issue(s) that would impede the accurate and timely claims review. Work with management to ensure that these issues are resolved. 
• Give feedback to management regarding query effectiveness and new query ideas. 
• Acquire knowledge of the client’s claims adjudication system, provider contracts, and basic client claim payment policies and procedures. Communicate with management issues that may affect the review of claims. 
• Communicate any discrepancies in the client’s data as loaded in the data mining internal system. 
• Validate claims to ensure the accuracy of query results and that no refund has previously been posted to clients’ systems. 
• Work with management to clarify matters as they arise through the course of review. 
• Inform the manager of trends discovered in the review and validation process. 
• Contact appropriate parties to confirm that a valid claim has been identified. This could include but not limited to Providers, Members, and/or Other Health Insurance Carriers. 
• May work with Accounts Receivable staff to research and/or answer questions from providers regarding overpayments. 

 Why choose ClarisHealth?

• ClarisHealth unites data and people through innovative technology.
• Remote-first flexible working environment
• OUR AMAZING BENEFITS
• Health insurance, including $0 premium HDHP and $0 deductible PPO options. FIRST-DAY COVERAGE!
• Generous Paid Time Off: 4 weeks PTO, 1 week Wellness Time, 2 days volunteer time off, 9 holidays, 2 floating holidays
• 401(k) with matching, immediate vesting
• “Got Your Back” environment
• We work hard, but we know how to take time and enjoy life

ClarisHealth embraces a supportive working culture of creativity and innovation internally termed “Got Your Back.” We live out this #GYB spirit every day by leading with Compassion, Communicating with transparency, and committing to improving our Community. Applicants must be currently authorized to work in the United States on a full-time basis. ClarisHealth is not able to sponsor applicants for work visas. ClarisHealth is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the People Operations team.

For more information about ClarisHealth and our culture, please visit us at https://www.clarishealth.com/careers/. #GYB

Help develop the industry-leading solution for the healthcare payer market. Join our team at ClarisHealth in challenging the traditional paper-based, time- and labor-intensive audit and data mining methods and impact the evolution of claims payment recovery.

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. Founded in 2013, we provide health plans and payers with total visibility into payment integrity operations through our advanced cost containment technology Pareo®. Pareo enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. Currently, nearly 33 million lives are served by our total payment integrity platform.

EOE including Disability/Veterans