Southwest Services Administrators

Claims Auditor

US-AZ-Phoenix
6 months ago(6/2/2017 2:57 PM)
Job ID
2017-1063
# of Openings
1
Category
Claims

Overview

Southwest Service Administrators is a Third Party Administrator (TPA) providing unique and specialized administrative services to labor-management Trust Funds (primarily) in the southwest United States with offices in Phoenix, AZ (our corporate service center), Albuquerque, NM and Salt Lake City, UT since 1995.

 

We offer competitive wages and an excellent benefit package including FULL FAMILY coverage for medical, dental, vision & Rx. Other benefits include (employee) short & long term disability, Life/AD&D Insurance, 401k, Pension, generous Paid Personal & Vacation Leave policy and career advancement and travel opportunities.

 

Southwest Service Administrators is currently hiring an experienced Claims Auditor.  The focus of this position is to assist the Claims Manager with a variety of projects related to the administration and adjudication of benefit payments. Primarily, the Claims Auditor will administer the company’s Quality Assurance Program and independently audit claims as assigned by the program/system.

Responsibilities

  • Conduct electronic (and hard copy) review of claims to identify potential errors based on plan design and/or industry Best Practices and in accordance with corporate standards.
  • Track individual audit results and compile data for the Claims Manager’s review.
  • Maintain and track audit results to identify training needs or system deficiencies. Support the claims department with quality assurance reporting and recommendations for continuous improvement based on audit results.
  • Maintain a thorough working knowledge of all plans in order to support the company’s quality assurance standards.

Qualifications

  • 3- 5 years of complex medical claims handling experience required; experience in a trainer or facilitator capacity preferred.
  • Strong knowledge of the health insurance industry including coordination of benefits methods, claims processing skills and some experience/history with dental & vision claims.
  • Maintain an interactive, engaging and collaborative learning environment
  • Detail oriented with strong organizational and time management skills with the ability to work within a deadline driven and changing environment as well as perform multiple tasks effectively and concurrently
  • Comply with all required policies, regulations and procedures applicable to the learning process
  • Experience in use of Medical Claims Processing software programs 
  • Intermediate proficiency with Microsoft Word and Excel 

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