Remote Claims Audit & Data Integrity Specialist

MagnaCare; Nevada (IA); On-site; USD 60,000 - 90,000; Full time

Job summary

MagnaCare is seeking an experienced auditor to perform routine and complex audits across enrollment, claims adjudication, and data integrity projects. The role involves developing audit results, explaining errors to staff, and identifying root causes relating to system configurations and manual processes.

We value strong analytical abilities, effective communication, and collaboration with training teams to target areas for refresher sessions.

Qualifications

• High School or Diploma.
• Minimum 5 years in auditing of claims adjudication.
• Working knowledge of medical terminologies and coding.
• Proficient in Word, Excel, Outlook, and PowerPoint.
• Strong analytical aptitudes, communication, and comprehension capabilities.

Responsibilities

• Perform routine and complex audits including enrollments & maintenance, claims adjudication & adjustments, member & provider data integrity in the claim.
• Develop, prepare and report results of audits; and provide error statements for explanation of errors to audited staff and management.
• Assist in identifying the root cause of errors in line to system configuration vs manual processing.
• Partner with Trainers to identify areas/topics for new/refresher training and assist with the documentation.

Skills

Auditing

Analytical skills

Communication

Education

High School Diploma

Tools

MS Office

Word

Excel

Outlook

PowerPoint

Medical terminology

Job description

MagnaCare is seeking an experienced auditor to perform routine and complex audits across enrollment, claims adjudication, and data integrity projects. The role involves developing audit results, explaining errors to staff, and identifying root causes relating to system configurations and manual processes.

We value strong analytical abilities, effective communication, and collaboration with training teams to target areas for refresher sessions.