Claim Department Auditor
Allied Benefit Systems, LLC, United States
Job Description
Job Title: Claim Department Auditor
Department: Claim Department
FLSA Status: Exempt
Job Status: FT
Reports To: Claims Management Team
Positions Supervised: None
Work Schedule: Flexible full-time hours
Assessments: PI Behavioral and Cognitive assessments
POSITION SUMMARY
The claim department auditor will be responsible for coordinating and completing audits as well as compiling and reporting results and trends accurately, appropriately and timely.
ESSENTIAL FUNCTIONS
- Logging/Tracking all Claims/Tasks to be audited
- Audit for accuracy as well as workflow compliance; Release of appropriate claims using established workflows
- Assist with all audit programs currently in place as well as identifying issues for future audit programs
- Assist with other tasks as needed and identified by Claims Management
- Monthly meetings with Claims Management to report on audit trends and training suggestions
- Other duties as assigned
POSITION QUALIFICATIONS
Communication Communicates effectively both internally and externally, where applicable. Includes both written and verbal communication.
Customer Focused Works well with customers/clients both internal and external, promotes a positive image of the company and department, and strives to solve issues raised by customers.
Dependability Meets deadlines, works independently, accountable, maintains focus, punctual, and maintains good attendance record.
Initiative Takes action independently, seeks new opportunities, and strives to see projects to completion.
Interpersonal Skills Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback.
Job Knowledge Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.
Organization Skills Information organized and accessible maintains efficient work space, and manages time well.
Problem Solving Strives to understand contributing factors, works to resolve complex situations.
Productivity Manages workload, works efficiently, and meets goals and objectives.
Self-Development Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements.
Sense of Urgency Meets deadlines, establishes appropriate priority, and completes tasks assigned in timely manner.
Teamwork Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.
Technical Skills Maintains current understanding of technical process/equipment, uses technology to increase performance/productivity; effectively uses online tools and resources.
SKILLS amp; ABILITIES
Applicant should be proficient in the use of the Excel and Word programs and able to communicate effectively by email.
Experience
Applicants must have 5 years of comprehensive experience with the processing or auditing of medical, dental and vision claims. The applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied. Auditing experience is preferred, but not required.
Education
High School degree required
Physical Demand
This role requires long periods of typing, sitting, and computer work
WORK ENVIRONMENT - This will be an off-site position with the applicant providing their own internet service.