Claims Auditor

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

Job summary

University Health in San Antonio, TX is seeking a skilled claims auditor to develop and maintain a comprehensive auditing program across all lines of business, aiming to improve processing standards and the overall quality of service provided to customers.

The role requires knowledge of HCFA/UB92 processing for commercial and Medicaid, plus Amisys CFHP systems, and a minimum of five years in insurance or managed care, including claim processing experience.

Qualifications

• High school diploma or equivalent.
• Minimum five years in insurance, medical or managed care environment.
• Two years of claim processing experience required.
• Auditing experience and Amisys knowledge preferred.

Responsibilities

• Develop and maintain claims auditing program for all lines of business to improve claims processing standards and monitor service quality.
• Identify processor and phone representative training needs to improve performance.
• Monitor the quality of service delivered to our customers.

Skills

Claims auditing

Claims processing

CFHP knowledge

Amisys

Education

High school diploma or equivalent

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.