Auditor, Claims BCI

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Ensure that claims are managed in accordance with internal operating procedures and the relevant employer-group plan language.

• Oversee audit workflows to guarantee timely processing.

• Maintain workload in alignment with quality and productivity benchmarks.

• Document audit findings for monthly reporting purposes.

• Collaborate with the supervisor to develop and facilitate training sessions.

• Mentor claims team members, particularly new trainees.

• Suggest dollar authorization levels based on audit results and interactions with the claims team.

• Support specialized audits involving SOC, carriers, vendors, and employers.

• Stay informed about benefits, state regulations, federal guidelines, and system updates.

• Evaluate complex claims and offer expertise to the claims team.

• Act as a liaison between clients, management, colleagues, and various organizational departments.

• Oversee processes related to refunds, voids, and stop-payments.

• Provide support on claims-processing inquiries.

• Assist with testing during system upgrades.

• Perform other assigned responsibilities as needed.

⛳️ Requirements

• High school diploma or GED is required.

• A minimum of 5 years of experience in processing medical, dental, vision, FSA, and HRA claims.

• Thorough knowledge of CPT, HCPCS, ICD-9, and ICD-10 medical coding systems.

• Exceptional attention to detail along with strong organizational abilities.

• Proven problem-solving skills in a dynamic production environment.

• Outstanding verbal and written communication skills.

• Proficient in PC navigation within a professional setting.

• Basic knowledge of MS Excel.

• Basic knowledge of MS Word.

• Capacity to exercise judgment and utilize available resources for sound decision-making.

• Ability to work autonomously as well as collaboratively within a team.

🏝️ Benefits

• Competitive salary and performance incentives.

• Comprehensive health benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork.