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POSITION OVERVIEW AND RESPONSIBILITIES
The Claims Auditor is accountable for the creation and upkeep of a comprehensive auditing framework for claims across various business sectors, aimed at enhancing claims processing protocols and assessing the quality of service provided to clients.
This role involves pinpointing training requirements for processors and customer service representatives to bolster their performance.Applicants should possess a solid understanding of claims processing for HCFA and UB92 formats, applicable to both commercial and Medicaid sectors, along with familiarity with the CFHP claims payment processing system, Amisys.
EDUCATIONAL BACKGROUND AND EXPERIENCE
A minimum of a high school diploma or equivalent is mandatory.
Candidates should have at least five years of experience in the insurance, healthcare, or managed care fields, including a minimum of two years in claims processing. Previous experience in auditing and/or with the Amisys system is highly regarded.
