Auditor (Claims)

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

Benefits offered by this job

Medical, dental, vision

Short-term disability

Company-paid long-term disability & L/

401K with company match

Paid time off

Job summary

Southwest Service Administrators, Inc. is seeking a Claims Auditor in Phoenix, AZ to perform audit activities for medical and dental claims and support the team manager with statistical reports and documentation.

The role requires three years of claims analysis experience, strong knowledge of medical terminology and CPT/ICD codes, and proficiency in MS Excel and Word. Health benefits and a comprehensive compensation package are offered.

Qualifications

• Must have a High School Diploma or GED.
• Three years of recent experience analyzing medical claims.
• Excellent attention to detail and accuracy in audits.

Responsibilities

• Audit medical and/or dental claims and document findings.
• Prepare management reports summarizing observations and recommendations.
• Research claim processing issues to determine origin and resolution.
• Assist in testing system functionality during upgrades and implementations.
• Maintain knowledge of policies, procedures, compliance regulations, and benefits schedules.

Skills

Attention to detail

Medical terminology

CPT/ICD codes

Typing speed 40 wpm

Strong communication

Education

High School Diploma/GED

Tools

MS Excel

MS Word

Job description

Job Details: Job Location: Phoenix, AZ - Phoenix, AZ, Salary Range: $19.00 - $25.50, 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

• 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

• 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

• 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.

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.