Perform quality review on claims, enrollment, and member service personnel on select criteria determined by management. Audit personnel daily of randomly selected output and complete appropriate forms for manager/supervisor feedback. Will work closely with trainer on training needs identified through the quality review process.
- High school graduation required. Associates degree preferred.
- Four years claim related processing experience.
- One to two years quality review/auditing experience preferred.
- Ability to read and have a clear understanding of claims processing manuals, medical terminology, CPT codes and perform claims processing procedures.
- Knowledge of claims processing manuals and health benefit booklets.
- Excellent interpersonal skills and the ability to work with individuals at all levels in the organization.
- Successful completion of Health Care Sanctions background check
- Ability to perform detailed math calculations.
- Proficiency in the use of personal computers including claims processing software.
- Familiarity of Excel preferred.
- Access and Word experience preferred.
- Self motivated with the ability to handle multiple tasks, work independently with minimal direction and meet stringent deadlines.
- Ability to converse and write fluently in English.