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Description

As a Medical Claim Field Auditor, you will apply your medical claims audit, project management and claim processing and auditing experience to perform self-insured client audits. You will serve as a team member on audits, evaluate claims for accuracy and identify potential errors and issues.

The Responsibilities

+ Understand self-insured client’s plan designs

+ Audit claims using the administrators claims system to determine if claims were adjudicated in error

+ Submit error inquiries and perform research on administrators’ claim systems during the audits

+ Clearly communicate and professionally interact with administrator and audit team

+ Understand administrators’ processes, operating environment, and specific challenges and take them into account with daily work

+ Develop working relationship with vendor counterparts

+ Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings

+ Efficiently utilize audit-specific analytic techniques, tools and processes

+ Ensure that Professional Excellence protocols are followed

+ Meet billable hours target

+ Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery

+ Role will be working remotely within the posted locations.

Qualifications

Qualifications

+ 5+ years’ experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment

+ Solid understanding of health and welfare plan design and all areas of claims administration, as well as of vendors’ processes and operating environment

+ Claims processing knowledge/exposure to one or more administrator claim systems such as UNET, WGS, NASCO, ACAS, Proclaim, PowerMHS, Facets, ITS, Bluechip

+ Familiarity with all plan types including consumer-driven, PPO, POS, Indemnity and Managed Care

+ Must demonstrate a high level of professional and facility claims administration knowledge, including experience with medical, dental, mental health and Medicare

+ Must have detailed knowledge of ICD-10 and CPT and revenue codes and coding protocols

+ Excellent oral and written communications skills

+ Team player with strong work ethic

+ Self-directed; requiring very little supervision

+ Previous audit experience at a carrier or third-party external audit experience a plus

+ Bachelor’s degree preferred; high school diploma required

Compensation and Benefits

Base salary range and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that base salaries may vary for different individuals in the same role based on several factors, including but not limited to location of the role, individual competencies, education/professional certifications, qualifications/experience, performance in the role and potential for revenue generation.

Compensation

The base salary compensation range being offered for this role is $75,000 to $82,000 USD per year.

This role is also eligible for an annual short-term incentive bonus.

Company Benefits

WTW provides a competitive benefit package which includes the following (eligibility requirements apply):

+ Health and Welfare: Mental health/emotional wellbeing (including Employee Assistance Program), medical (including prescription drug coverage and fertility benefits), dental, vision, Health Savings Account, Commuter Accounts, Health Care and Dependent Care Flexible Spending Accounts, company-paid life insurance, supplemental life insurance, AD&D, group accident, group critical illness, group legal, identity theft protection, wellbeing program, adoption assistance, surrogacy assistance, auto/home insurance, pet insurance, and other work/life resources.

+ Leave Benefits: Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off (https://cdn-static.findly.com/wp-content/uploads/sites/1862/2023/01/31091722/Washington-State-Time-Off.pdf)

+ Retirement Benefits: Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans.

Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records.

Note that visa employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.

This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified.

EOE, including disability/vets