Claims Auditor

WM MICHAEL STEMLER INC

Stockton, CA Job Details Full-time $22 - $26 an hour 9 hours ago Qualifications Microsoft Word Microsoft Excel Word embeddings Dental insurance Medical claims processing software Health insurance knowledge Full Job Description Audits Claims, Customer Service and OA personnel by performing the following duties. Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines. Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service. Documents, maintains and reports audit statistics Accurately interprets claim policy, procedures and standard group benefit provisions Provides feedback to management and reviewed employees regarding quality of work Maintains confidentiality of employee audits Adheres to company rules and regulations. Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner Performs other duties as assigned

EDUCATION/EXPERIENCE

One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience.

QUALIFICATIONS

Successful candidate will have medical, dental and hospital claims processing experience; a strong understanding of computerized claims payment systems, preferably at Delta Health Systems; excellent organizational skills; a thorough understanding of technical claims issues and system edits; working knowledge of Microsoft Word and Excel; and exceptional analytical skills.