Claims Auditor

Community First Health Plans; San Antonio (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

A health plans organization in San Antonio is seeking a Claims Auditor to manage and enhance their claims auditing program. The role involves overseeing claims processing standards and ensuring high-quality service delivery to customers. Candidates should have at least five years of experience in the insurance or managed care sectors, with a focus on claims processing. A high school diploma is required, with preference for those having auditing experience and knowledge of the Amisys system.

Qualifications

• Minimum of five years experience in insurance or managed care environment.
• Two years of claim processing experience required.
• Previous auditing and/or Amisys experience preferred.

Responsibilities

• Develop and maintain claims auditing program.
• Improve claims processing standards.
• Monitor quality of service delivered to customers.

Skills

Claims auditing

Claims processing

Training needs

Amisys

Insurance industry

Education

High school diploma or equivalency

Experience in insurance, medical or managed care

Tools

Amisys

Job description

POSITION SUMMARY/RESPONSIBILITIES

Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowledge of CFHP claims payment processing system, Amisys.

EDUCATION/EXPERIENCE

High school diploma or equivalency is required. Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.