Claims Quality Auditor & Training Liaison

CommunityCare HMO, Inc.; Tulsa (OK); On-site; USD 42,000 - 60,000; Full time

Job summary

CommunityCare HMO, Inc. in Tulsa, OK is seeking an Operational Support - Claims Review Analyst to perform quality reviews of claims, enrollment, and customer service output.

You will audit daily, complete forms for feedback, and collaborate with trainers to address training needs identified through the review process. The role requires reading claims processing manuals, understanding CPT codes, and communicating effectively with staff at all levels.

Qualifications

• Ability to read and understand claims processing manuals, medical terminology, CPT codes and perform claims processing procedures.
• Knowledge of claims processing manuals and health benefit booklets.
• Excellent interpersonal skills and the ability to work with individuals at all levels in the organization.
• Successful completion of Health Care Sanctions background check.
• Ability to perform detailed math calculations.
• Self-motivated with the ability to handle multiple tasks and meet deadlines.

Responsibilities

• Audit claims, enrollment and customer service personnel daily of randomly selected work and complete appropriate forms related to the audits.
• Answer questions for claims, enrollment and customer service personnel.
• Establish training needs for employees identified during the quality review process.
• Perform other job-related duties as assigned.

Skills

Claims processing

CPT codes

Microsoft Office

Interpersonal communication

Quality auditing

Education

High school diploma or equivalent

Associates degree preferred

Tools

Microsoft Office

Job description

CommunityCare HMO, Inc. in Tulsa, OK is seeking an Operational Support - Claims Review Analyst to perform quality reviews of claims, enrollment, and customer service output.

You will audit daily, complete forms for feedback, and collaborate with trainers to address training needs identified through the review process. The role requires reading claims processing manuals, understanding CPT codes, and communicating effectively with staff at all levels.