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Claims Auditor

2 months ago

Maryland Heights, United States Magellan Health Services inc Full time
This position supports management in the design, implementation, and maintenance of claims auditing programs. Responsible for auditing claims for accuracy. Verify that claims are being adjudicated according to Magellan contracts in a consistent and accurate manner. Work closely with claims department to report issues and determine resolutions.
  • Reviews benefit plans to ensure that claims are being adjudicated accurately and consistently according to Magellan contracts. Audits claims for financial accuracy.
  • Responsible for documenting and reporting issues found.
  • Assists with the establishment and updating of processes and audit manuals.
  • Identifies areas where issues exist and works with appropriate individuals to ensure resolution
  • Completes special focused audits as assigned by management.
  • Trains and mentors new auditors; works with trainers to audit and develop trainees.
  • Act as a resource for the auditing team.

Other Job Requirements

Responsibilities
An understanding of contracts, business and insurance principals related to claims adjudication.
Requires abilityto read and understand benefit plans.
Experience with multiple claim processing systems.
Knowledge of coordination of benefit guidelines.
An understanding of the adjustment and resolution process.
Good interpersonal skills.
Must function independently with strong organizational skills.
Ability to handle multiple accounts and priorities.
Strong verbal and written communication skills.
Minimum 1 year health claims audit experience.

General Job Information

Title
Claims Auditor

Grade
20

Work Experience - Required
Claims

Work Experience - Preferred

Education - Required
GED, High School

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:
$41,505
Salary Maximum:
$62,255

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.