Auditor (Claims)

Southwest Service Administrators; Phoenix (AZ); On-site; USD 26,000 - 34,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Short-term Disability

401K with match

Pension plan

Paid time off

Job summary

Southwest Service Administrators in Phoenix, AZ is seeking a Claims Auditor to handle audit activities for medical and/or dental claims and support management with statistical reports.

The role requires knowledge of medical terminology, CPT/ICD codes, and experience in analyzing claims, with strong Excel and Word skills and attention to detail. On-site position with competitive benefits.

Qualifications

• High School Diploma or GED required.
• Three (3) years of recent experience analyzing medical claims.

Responsibilities

• Auditing & Reporting: perform audit activities for medical and/or dental claims and prepare reports for management.
• Gain and maintain understanding of plan designs and apply knowledge.
• Maintain knowledge of policies, procedures, compliance, schedules, and turnaround times across product lines.
• Research claim processing issues to determine origin and resolution.
• Assist in testing system functionality during upgrades and implementations.
• Participate in team meetings and training activities.
• Complete additional responsibilities as assigned.

Skills

Medical terminology

CPT/ICD knowledge

Documentation analysis

40 WPM typing

MS Excel

MS Word

Attention to detail

Communication

Education

High School Diploma/GED

3 years medical claims analysis

Tools

MS Excel

MS Word

Job description

Job Details

Job Location: Phoenix, AZ - Phoenix, AZ 85027

Salary Range: $19.00 - $25.50 Hourly

The Claims Auditor is responsible for all audit activities for medical and/or dental claims while supporting the team manager to create, maintain and provide statistical audit reports and documentation.

Responsibilities

• Auditing & Reporting
• Gain and maintain the understanding of the plan designs and effectively apply that knowledge.
• Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines
• Research claim processing issues to determine the origin and appropriate resolution
• Prepare reports for management summarizing observations and recommendations
• Assist in testing system functionality during upgrades and implementations
• Teamwork
• Work cooperatively with other team members
• Actively participate in team meetings and training activities.
• Perform additional responsibilities and projects as periodically assigned.

Qualifications

Education/Certification:

• High School Diploma/GED
• Three (3) years recent experience analyzing medical claims

Skills/Abilities

• Ability to maintain production and quality standards.
• Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.
• Ability to read, analyze and assess medical documentation and draw valid conclusions.
• Minimum 40 WPM and 3,000 KPH proficiency
• Solid knowledge of MS Excel & MS Word
• Professional, client-focused approach to colleagues and assignments.
• Strong oral and written communication skills with exceptional attention to details.
• Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
• Strong dedication to follow-through on all tasks and assignments.
• Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.
• Ability to sit for long periods of time operating a computer keyboard.

Employee Benefits Program

COMPANY PROVIDES:

• MEDICAL, DENTAL, VISION
• SHORT-TERM DISABILITY
• Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%.
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

EEO Statement

Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.