Medical Claims Auditor

Claims Auditor - Trainer

Well established employer in Newtown Square, Delaware County, Pennsylvania has a need for a full-time Claims Auditor - Trainer.

The company offers a competitive salary, excellent employer-paid benefits such as 401k and defined benefit plan, generous PTO, holiday pay, and a pleasant working environment.

This non-exempt position consists of a 37.50-hour work week with daily work hours of 8:30am to 5:00pm Monday through Friday.

About the role:

The position is responsible for auditing the health plan claims accuracy for manually processed claims as well as any claims adjudicated electronically via BlueCross, Guardian, Medicare Crossover and SDS. The position is also responsible for any in-house training for all new claims employees or of existing claims personnel on any changes.

Key Responsibilities Include:

· Responsible for auditing claims for accuracy and maintaining a 99.55% accuracy rating on all audited claims,

· Responsible for identifying errors and making the proper adjustments as needed,

· Responsible for finalizing claims in BlueCross CADF and GUI systems,

· Responsible for all in-house training of all new claims examiners or member service representatives on the company health plan benefits, procedures, and the claim payment systems,

· Responsible for training all existing claims personnel on plan benefit and system changes,

· Responsible for completion and accurate release of claims that require adjustments,

About You:

· Minimum of 2 years of college and/or completion of insurance courses preferred,

· Minimum of 2 years of hands-on experience processing online medical claims and/or related computer experience required,

· Previous teaching/training experience preferred,

· Previous knowledge of a health benefit plan and claims adjudication system preferred,

· Previous computer experience (Microsoft Office Suite or related) required,

· Must be reliable and have acceptable and predicable attendance,

· Excellent interpersonal skills and communication skills,

· Strong analytical skills,

· Must be detail oriented,

· Proficient computer skills with the ability to learn new software,

· Knowledge of Current Procedure Terminology (CPT) and ICD codes,

· Knowledge of preferred provider Organization (PPO) network experience preferred,

· Must be able to maintain prolonged periods of sitting at a desk, talking on the phone and working on a computer

E.O.E./M/F/H/V

Job Type: Full-time

Pay: $19.00 - $21.00 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• No weekends

Work setting:

• Hybrid work
• Office

Ability to Relocate:

• Newtown Square, PA 19073: Relocate before starting work (Required)

Work Location: Hybrid remote in Newtown Square, PA 19073