Senior Associate – Health Claims Quality Auditor

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

📋 Description

• Supervise and direct performance as well as service quality to ensure customer satisfaction.

• Establish and uphold communication with clients and/or team members; comprehend their needs, resolve issues, and fulfill expectations.

• Convey critical information through prompt and precise reporting.

• Develop effective strategies grounded in data reports, analysis, and observations.

• Review healthcare claims to identify billing errors, discrepancies, or potential fraud.

• Assist in process documentation and initiatives aimed at quality improvement.

⛳️ Requirements

• Experience in US Healthcare, with knowledge of managing commercial and/or Medicaid claims processes.

• Significant experience with high-dollar claims.

• Familiarity with standard claim forms such as CMS-1500 and UB-04.

• A minimum of 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.

• Capability to identify minor billing errors, discrepancies, or potential fraud.

• Excellent written and verbal communication skills.

• In-depth knowledge of complex commercial payer contracts, reimbursement methodologies, and federal Medicare/Medicaid regulations.

• Proficient in process documentation.

• Ability to work with MS Office applications.

• Capacity to thrive in a fast-paced environment.

• Proactive in building trust and professional relationships with colleagues and team members; adopt a team-player mentality.

• Strong analytical abilities; adept at interpreting data, identifying trends, and recommending enhancements.

🏝️ Benefits

• Comprehensive health benefits.

• Competitive salary and performance bonuses.

• Opportunities for professional development and career advancement.

• Flexible work hours and a supportive work environment.