• Medical Claims Auditor

    Robert Half Accountemps (Los Angeles, CA)


    Description

    The Claims Auditor reports functionally to the Administrative Manager but takes most direction from the Claims Manager. The Claims Auditor is responsible for reviewing all processed claims for accuracy of the payment release. Provide back-up support to audit Member Service Representatives, fielding incoming telephone calls from members and providers, processing claims, and adjusting claims as needed upon request of Clams Manager. The Auditor will be responsible for the monitoring of claims to ensure compliance with the Summary Plan Description, Federal and State Mandates, and Quarterly updates as dictated by the Board of Trustees.

     

    + Review all claims for potential fraud, waste and abuse.

    + Perform, assist, and conduct daily audits, focus audits, and random audits of claim payment as established in the Claims Department Policies and Procedures.

    + Distribute, log, and report daily audits, focus audits, and random audits of claim payment and provider/member calls.

    + Report daily audits, focus audits, and random audits of claims payments and provider/member calls to the Claims Manager with a stat report.

    + Report productivity to Claims Manager.

    + Ensure compliance with the organization’s Policies as well as County, State, Federal and other regulatory bodies.

    + Communicate issues and suggestions on process improvements to improve the Department.

    + Run and resolve various claims reports to resolve Held Audits, Prepayment audits to make sure claim payments meet the standards dictated by the Department Policies and Procedures.

    Requirements

    Medical Claims, IPA, Claims Adjudications

     

    Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

     

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    Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

     

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