Medical Claims Auditor / Trainer - (Health Insurance, CPT, ICD-10)
- Medical , Paid Time Off , Retirement
- Full-Time
Medical Claims Auditor / Trainer
(Health Insurance)
(CPT, ICD-10)
Newtown Square, PA
(Full Time, Permanent Role)
We are an established employer in Newtown Square, Delaware County, Pennsylvania, and are seeking a full-time Claims Auditor - Trainer to join our team.
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:
This position is responsible for auditing the Health Plan claims for accuracy including manually-processed claims as well as any claims that were 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,
E.O.E./M/F/H/V
About You:
· Minimum of two (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,
Benefits:
We offer a Competitive salary, with excellent "employer-paid" benefits such as:
401k
Defined Benefit Plan
Generous PTO
Holiday pay
Pleasant working environment.
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