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USA

Claims Audit Analyst

locationMaryland - Maryland (MD),

atPiper Companies

Estimated salary $42,000 - $52,000 a year

Job Description:

Piper Companies is actively seeking candidates for a remote Claims Audit Specialist to support a nationwide healthcare insurance company. The Claims Audit Specialist will work directly with the Compliance & Quality Assurance department to analyze and identify gaps in claims processing across the company.


Responsibilities for the Claims Audit Specialist include:

  • Analyze claims processing data and identify common errors and potential gaps in claims processing protocols
  • Develop recommendations for process improvement based on audit findings and provide feedback to individual claims team members and department leaders
  • Conduct ongoing quality reviews of current claims queues to ensure correct processing of ongoing incoming claims
  • Conduct quality review of functions performed and maintain documentation mandated by control activities and financial audits
  • Engage in department projects to ensure work performed is accurate, complete, and improved
  • Provide feedback
to improve how employees and departments can eliminate repeated errors
  • Act on corrections to policies, systems, and procedures to establish a higher quality of work is performed

  • Requirements for the Claims Audit Specialist include:

    • 1+ year of relevant experience in healthcare quality reviews and claims processing improvement
    • 2+ years of healthcare claims processing experience
    • High School Diploma or G.E.D. Required


    Compensation for the Claims Audit Specialist include:

    • Salary Range: $42,000 – $52,000 based on relevant experience
    • Benefits: Health, Dental, & Vision Insurance, 401K


    Keywords

    Healthcare, healthcare claims, Claims processing, quality assurance, QA, conduct, quality, audit, analyst, data, claims, identify, compliance, compliance and quality, department projects, gaps, processing, medical, billing, assurance, reviews, corrections, policies, systems, quality, process, processing, improvement, QC

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