Claims Auditor: Drive Cost Savings & Family Healthcare

Redirect Health; Phoenix (AZ); Presencial; USD 50 000 - 55 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Free healthcare for you and your whole

Dental & Vision insurance

Paid time off

Resumo da oferta

Redirect Health in Phoenix is seeking a Dedicated Claims Auditor to oversee medical and pharmacy claims auditing practices for our members. You will help ensure payment accuracy, coding appropriateness, and adherence to plan provisions in a fast-paced environment.

You will review high-dollar and complex claims, identify overpayments, and support recovery efforts. We offer free healthcare for you and your family, dental and vision coverage, a 401(k), and a mission-driven team.

Qualificações

• 2+ years in a dedicated claims and/or auditing role, preferably in healthcare or customer service.
• Strong system and rules analysis, problem‑solving, and decision‑making abilities.
• Excellent communication and interpersonal skills.

Responsabilidades

• Claims Audit, Review, & Quality Assurance.
• Perform detailed audits of medical and pharmacy claims to verify payment accuracy, coding appropriateness, and adherence to plan provisions.
• Validate claims against internal reimbursement methodologies, contracts, fee schedules, and plan documents.
• Review high-dollar, complex, and outlier claims for billing accuracy and reimbursement integrity.
• Payment Integrity and Cost Containment.
• Identify claim overpayments, underpayments, and recovery opportunities.
• Analyze reimbursement trends and claim payment anomalies.
• Support recovery efforts through reprocessing recommendations and financial impact analyses.
• Recommend process improvements to reduce claim leakage and optimize plan spend.

Conhecimentos

Claims auditing

System analysis

Problem solving

Decision making

Communication

Descrição da oferta de emprego

Redirect Health in Phoenix is seeking a Dedicated Claims Auditor to oversee medical and pharmacy claims auditing practices for our members. You will help ensure payment accuracy, coding appropriateness, and adherence to plan provisions in a fast-paced environment.

You will review high-dollar and complex claims, identify overpayments, and support recovery efforts. We offer free healthcare for you and your family, dental and vision coverage, a 401(k), and a mission-driven team.