Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Description
SUMMARY
The Claims Auditor is responsible for testing and evaluating the audits, ensuring compliance with pre-established Procedures, Agreements, and Audit Protocol. In addition, the Claims Auditor is equally responsible for administrative tasks outside the audit queues assigned by the Audit Supervisor. The Claims Auditor should have knowledge of commonly-used concepts, practices, and audit procedures. Works under immediate supervision in a collaborative team environment.
PRIMARY RESPONSIBILITIES
Requirements
KNOWLEDGE AND SKILL REQUIREMENTS/COMPETENCIES
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0 Claims Quality Auditor jobs found in Trenton, NJ area