Remote Claims Auditor - Healthcare Compliance & QA

SCAN Health Plan; Lakewood (CA); Remote; USD 35.000 - 51.000; Vollzeit

Benefits dieser Stelle

Remote work

Annual bonus

Wellness program

PTO

Holidays

401(k)

Tuition reimbursement

Employee recognition program

Zusammenfassung

SCAN Health Plan is seeking a Claims Auditor to perform audits of claims payments and denials, ensuring accuracy and regulatory compliance across California and beyond. The role supports pre-pay and post-pay reviews, and requires strong knowledge of CMS rules and COB/DOFR practices.

The position offers remote work options, an annual bonus, a robust wellness program, comprehensive PTO, holidays, and a 401(k) plan.

Qualifikationen

• 3+ years of complex claims processing and/or auditing experience in health plan or managed care.
• Strong knowledge of CMS requirements regarding claims processing.
• Experience with DOFR (Division of Financial Responsibility) and COB (Coordination of Benefits).
• Experience with both Institutional and Professional claim payment.

Aufgaben

• Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials.
• Ensure regulatory compliance and quality/efficiency in claims processing.
• Work cases through SCAN’s workflow system and apply correct status attributes.
• Collaborate with other units to review and correct processing errors prior to final payment.
• Escalate claims/audit issues to management and follow policies and procedures.

Kenntnisse

Claims processing

Auditing

CMS knowledge

Ausbildung

Associate’s degree preferred

Tools

IKA

QNXT

Jobbeschreibung

SCAN Health Plan is seeking a Claims Auditor to perform audits of claims payments and denials, ensuring accuracy and regulatory compliance across California and beyond. The role supports pre-pay and post-pay reviews, and requires strong knowledge of CMS rules and COB/DOFR practices.

The position offers remote work options, an annual bonus, a robust wellness program, comprehensive PTO, holidays, and a 401(k) plan.