1+ months

Healthcare Claims Auditor - La Palma, CA

La Palma, CA 90623
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The Healthcare Claims Auditor is responsible for reviewing all processed claims prior to payment release, and respond to Health Maintenance Organization (HMO) Enrollees for Commercial, Medicare, and Medicaid Enrollees. Responsible for daily auditing of managed care claim payments. Will be responsible to monitor claims compliance with Medicare by auditing reports.  This person is the liaison with internal and external clients to resolve provider/member claim issues. Responsible to train claims examiners and is a resource relating to claims guidelines.

Primary Responsibilities
  • To perform daily audits of claims payments as established in the Claims Department Policies and Procedures
  • Work with Provider Disputes (PDR) and Appeals
  • To log all totals related to claims payment errors and examiner productivity for reporting purposes as established in the Claims Policies and Procedures
  • Trains claim examiners regarding the system and claim procedures
  • Audit pre check runs based on check run schedules
  • Run and resolve various claims reports prior to check run
  • Resolve claims based on CCI edit report to comply with CMS guidelines
  • Serves as a resource to Management, Customer service, UM and other departments on claim issues
  • To contribute to a fair and positive work environment by treating peers, superiors, subordinates, clients and vendor with professionalism and respect
  • We are looking for candidates with the following strong attributes:
    • Initiative - ability to thoughtfully and independently resolve problems
    • Organizational Skills - ability to prioritize individual and departmental workloads
    • Always follows through on work
    • Strong Reporting Skills
    • Technical and computer expertise
    • Communication - ability to identify and effectively communicate unresolved problems to Management in a timely manner
    • Teamwork/Workplace Civility - ability to work well with others and contribute to the overall positive work environment of both the Department and the Company
    • Demonstrates high reliability through consistent punctuality and attendance
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Posted: 2019-11-16 Expires: 2020-04-18

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Healthcare Claims Auditor - La Palma, CA

UnitedHealth Group
La Palma, CA 90623

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