Claims Auditor – TPA

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Conduct operational and quality audits on claims processing activities.

• Evaluate claims files, documentation, and processing workflows.

• Record audit results and compile audit reports, findings, and supporting documentation.

• Monitor audit outcomes and pinpoint trends, recurring issues, and areas for improvement.

• Present audit findings and assist in follow-up actions.

• Engage in the development, review, and enhancement of operational policies, procedures, and quality standards.

• Aid internal performance and compliance initiatives by providing data, insights, and documentation.

• Promote collaboration and feedback among functional teams.

• Organize meetings related to audits, quality initiatives, or process enhancements.

• Utilize technology, including emerging and AI-driven solutions, to foster efficient workflows, accuracy, and client service.

• Complete special projects and fulfill other assigned responsibilities.

⛳️ Requirements

• High school diploma or an equivalent qualification.

• At least 2 years of experience in claims processing and auditing.

• Capability to assess claims activity for accuracy, consistency, and adherence to established rules and guidelines.

• Exceptional attention to detail and strong analytical skills.

• Strong verbal and written communication abilities.

• Aptitude for documenting findings clearly and maintaining precise records.

• Proficiency in Microsoft Word and Excel.

• Willingness to learn new systems and software applications.

• Ability to juggle multiple priorities and meet deadlines in a structured environment.

• Dedication to confidentiality and the proper handling of sensitive information.

• Professionalism, tact, and discretion are essential.

🏝️ Benefits

• Family health and wellness programs.

• 401K plan.

• Employee assistance programs.

• Paid time off.

• Paid holidays.

• Opportunities for career advancement and development.

• Eligibility for a discretionary annual incentive program.